Provider Demographics
NPI:1043201601
Name:PACA, WENDY SUE (RN, MSN, ARNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:PACA
Suffix:
Gender:F
Credentials:RN, MSN, ARNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUE
Other - Last Name:KLESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2204
Mailing Address - Country:US
Mailing Address - Phone:515-832-6700
Mailing Address - Fax:515-832-3534
Practice Address - Street 1:510 BANK ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2204
Practice Address - Country:US
Practice Address - Phone:515-832-6700
Practice Address - Fax:515-832-3534
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAJ-090609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0423939Medicaid
IA0423939Medicaid
IAS96520Medicare UPIN