Provider Demographics
NPI:1114305133
Name:WESSELS HARWOOD, JENICA LYNN (MD)
Entity type:Individual
Prefix:
First Name:JENICA
Middle Name:LYNN
Last Name:WESSELS HARWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 NW FIELDING RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66618-2651
Mailing Address - Country:US
Mailing Address - Phone:785-270-0047
Mailing Address - Fax:
Practice Address - Street 1:4505 NW FIELDING RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66618-2651
Practice Address - Country:US
Practice Address - Phone:785-270-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine