Provider Demographics
NPI:1447858733
Name:WENDT, KELLY (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WENDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:DREWEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:204 MORRISSEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153-9732
Mailing Address - Country:US
Mailing Address - Phone:262-894-9216
Mailing Address - Fax:
Practice Address - Street 1:204 MORRISSEY DR
Practice Address - Street 2:
Practice Address - City:NORTH PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53153-9732
Practice Address - Country:US
Practice Address - Phone:262-894-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146649-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health