Provider Demographics
NPI:1447255526
Name:DUSENBURY, WENDY L (ARNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:DUSENBURY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 EASTMORELAND AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3519
Mailing Address - Country:US
Mailing Address - Phone:901-448-5227
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-448-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR218849758Medicaid
TNQ022757Medicaid
MS09983751Medicaid
MO144725526Medicaid
GA003182013AMedicaid