1609857606 NPI number — MS. WENDY WETZEL RN FNP

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	WETZEL
Provider First Name	:	WENDY
Provider Middle Name	:
Provider Name Prefix Text	:	MS.
Provider Name Suffix Text	:
Provider Credential Text	:	RN FNP
Provider Gender Code	:	F

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Provider Other First Name	:
Provider Other Middle Name	:
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NPI Number	:	1609857606
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	08/16/2011
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	PO BOX 6033
Provider Second Line Business Mailing Address	:	BUILDING 25
Provider Business Mailing Address City Name	:	FLAGSTAFF
Provider Business Mailing Address State Name	:	AZ
Provider Business Mailing Address Postal Code	:	860110181
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	9285238995
Provider Business Mailing Address Fax Number	:	9285231102

Provider First Line Business Practice Location Address	:	824 S. SAN FRANCISCO ST.
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	FLAGSTAFF
Provider Business Practice Location Address State Name	:	AZ
Provider Business Practice Location Address Postal Code	:	86001
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	9285238995
Provider Business Practice Location Address Fax Number	:	9285231102
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
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• Taxonomy code: 174400000X , with the licence number:  RN088989 , registered in the state of AZ .

• Identifier: RN 088989 . This is a "STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "".