Provider Demographics
NPI:1104483841
Name:BAGNESCHI, WENDY RAE (LMT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RAE
Last Name:BAGNESCHI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:RAE
Other - Last Name:VANWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1245 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-9384
Mailing Address - Country:US
Mailing Address - Phone:970-689-0068
Mailing Address - Fax:
Practice Address - Street 1:151 BORDEAUX ST # 25
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2169
Practice Address - Country:US
Practice Address - Phone:970-689-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist