Provider Demographics
NPI:1104818848
Name:RODEWALD, WENDY J (PA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:RODEWALD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 HIGHWAY 6
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4941
Mailing Address - Country:US
Mailing Address - Phone:281-494-4832
Mailing Address - Fax:281-494-7399
Practice Address - Street 1:1211 HIGHWAY 6
Practice Address - Street 2:SUITE 40
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4941
Practice Address - Country:US
Practice Address - Phone:281-494-7773
Practice Address - Fax:281-494-7796
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS16643Medicare UPIN
TX83N965Medicare ID - Type Unspecified
TX8368M6Medicare ID - Type Unspecified