Basic Information
| Provider Information | |||||||||
| NPI: | 1750846952 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LI | ||||||||
| FirstName: | WENDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 JACKSON ST NE APT 4110 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303127925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063836652 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1212 N PINES RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992064939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098938140 | ||||||||
| FaxNumber: | 5092277070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2019 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60931944 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.