Provider Demographics
NPI:1992949887
Name:WENDELL, KATHERINE MARGARET M (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARGARET M
Last Name:WENDELL
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 1:11609 DEER FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1104
Mailing Address - Country:US
Mailing Address - Phone:703-437-1943
Mailing Address - Fax:
Practice Address - Street 1:11609 DEER FOREST RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1104
Practice Address - Country:US
Practice Address - Phone:703-437-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001203352163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)