Provider Demographics
NPI:1588318893
Name:WENDTLAND, KRISTINE KAY
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAY
Last Name:WENDTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AVENUE C UNIT 5
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2475
Mailing Address - Country:US
Mailing Address - Phone:307-331-4484
Mailing Address - Fax:307-638-5035
Practice Address - Street 1:3511 KLIPSTEIN RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-9375
Practice Address - Country:US
Practice Address - Phone:307-331-4484
Practice Address - Fax:307-638-5035
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator