Provider Demographics
NPI:1285467324
Name:WEDEL, ANIKA J (RN)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:J
Last Name:WEDEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N GREENE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1520
Mailing Address - Country:US
Mailing Address - Phone:574-302-7602
Mailing Address - Fax:
Practice Address - Street 1:107 N GREENE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1520
Practice Address - Country:US
Practice Address - Phone:574-302-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28151736A163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical