Provider Demographics
NPI:1154393866
Name:WALMSLEY, WENDY J (FNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:WALMSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2572
Practice Address - Country:US
Practice Address - Phone:260-347-8030
Practice Address - Fax:260-347-8035
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000553A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200267490Medicaid
INP00782353OtherMEDICARE RR
IN911660TMedicare ID - Type Unspecified
INP00782353OtherMEDICARE RR
IN070860D8Medicare PIN
IN370640SMedicare ID - Type Unspecified
IN371310SMedicare ID - Type Unspecified