Provider Demographics
NPI:1083423214
Name:WENDT, ELIJAH SHEA
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:SHEA
Last Name:WENDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 RADIUS CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6869
Mailing Address - Country:US
Mailing Address - Phone:208-596-6269
Mailing Address - Fax:
Practice Address - Street 1:178 S 32ND ST W STE 3
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6889
Practice Address - Country:US
Practice Address - Phone:406-702-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant