Provider Demographics
NPI:1194937417
Name:COLLINI, WENDY RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RENEE
Last Name:COLLINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:309 REGENCY PKWY
Mailing Address - Street 2:SUITE #107
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5165
Mailing Address - Country:US
Mailing Address - Phone:817-477-5884
Mailing Address - Fax:817-477-5235
Practice Address - Street 1:309 REGENCY PKWY
Practice Address - Street 2:SUITE #107
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5165
Practice Address - Country:US
Practice Address - Phone:817-477-5884
Practice Address - Fax:817-477-5235
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00677GMedicare ID - Type Unspecified
TXE74032Medicare UPIN