Active NPI
Bonita J. Wendel, APNP/BC
- Nurse Practitioner
- Grafton, WI
National Provider Identifier
1053590323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 3244
- Practice address
- 2061 Cheyenne CT
Grafton, WI 53024-9368 - Phone
- (262) 376-1934
- NPI assigned
- Nov 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 3244 | WI | Primary |
Addresses
Primary practice location
2061 Cheyenne CT
Grafton, WI 53024-9368
Mailing address
4425 N Port Washington Rd
Attn: Csmcp Clinic Credentialing
Glendale, WI 53212-1082
Phone (262) 376-1934
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36050600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3244 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group-Fox Valley Wisconsin, Inc | Past | Accepting new patients | |
| Madison Medical Affiliates, Inc. | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/11299/brand/1/csg/1/fhir/r4
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Neenah, WI
- NPI 1730126392
-
- General Practice Physician
- Milwaukee, WI
- NPI 1588695746
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321315200000",
"number": "1053590323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4425 N PORT WASHINGTON RD",
"address_2": "ATTN: CSMCP CLINIC CREDENTIALING",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532121082",
"telephone_number": "262-376-1934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2061 CHEYENNE CT",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530249368",
"telephone_number": "262-376-1934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENDEL",
"first_name": "BONITA",
"middle_name": "J.",
"credential": "APNP/BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-02",
"last_updated": "2011-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "3244",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36050600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grafton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.