Basic Information
Provider Information
NPI: 1003012113
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NUNES
FirstName: WENDY
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: DAVIS
OtherFirstName: WENDY
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 235 STATE ST
Address2:  
City: SAINT CROIX FALLS
State: WI
PostalCode: 540244117
CountryCode: US
TelephoneNumber: 7154833221
FaxNumber: 7154830507
Practice Location
Address1: 235 STATE ST
Address2:  
City: SAINT CROIX FALLS
State: WI
PostalCode: 540244117
CountryCode: US
TelephoneNumber: 7154833221
FaxNumber: 7154830507
Other Information
ProviderEnumerationDate: 06/25/2007
LastUpdateDate: 11/23/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X50368WIY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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