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NPI Code Detail

MEDICARE: WENDY CLEMONS CANTRELL CRNP

MEDICARE: WENDY CLEMONS CANTRELL CRNP
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
1363LA2200XAdult Health Nurse Practitioner1-079199AL

General Provider Information

NPI Number : 1538100789
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY CLEMONS CANTRELL CRNP
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-663-9008
Fax Number : 920-684-1439
Provider Business Practice Location Address
First Line : 2900 CAHABA RD
Second Line :
City : MOUNTAIN BRK
State : AL
Zip : 35223-1937
Country : US
Telephone Number : 205-877-9773
Fax Number : 205-877-9775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 04/04/2025

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