Provider Demographics
NPI:1487608048
Name:WENDT, KAREN (CNM)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:WENDT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2657
Mailing Address - Country:US
Mailing Address - Phone:307-332-2223
Mailing Address - Fax:
Practice Address - Street 1:1460 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2657
Practice Address - Country:US
Practice Address - Phone:307-332-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8746.0044367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116968800Medicaid
WY116968800Medicaid
WY309160Medicare ID - Type Unspecified