MEDICARE: JEANETTE K WENDT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	17000	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104811397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE K WENDT MD

Provider Business Mailing Address
First Line	:	1631 W INA RD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1907
Country	:	US
Telephone Number	:	520-742-1833
Fax Number	:	520-742-7548

Provider Business Practice Location Address
First Line	:	1631 W INA RD STE 151
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1907
Country	:	US
Telephone Number	:	520-742-1833
Fax Number	:	520-742-7548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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Directions to “ JEANETTE K WENDT MD” Practice Location

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