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NPI Code Detail

MEDICARE: WENDY DIMMETTE M.D.

MEDICARE: WENDY DIMMETTE M.D.
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
1174400000XSpecialist96227NM

Other Identifiers

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

General Provider Information

NPI Number : 1477560589
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY DIMMETTE M.D.
Provider Business Mailing Address
First Line : 1214 NATIONAL AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4033
Country : US
Telephone Number : 505-425-7340
Fax Number : 505-425-7680
Provider Business Practice Location Address
First Line : 1214 NATIONAL AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4033
Country : US
Telephone Number : 505-425-7340
Fax Number : 505-425-7680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 07/08/2007

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