Active NPI
Jeanette K Wendt, MD
- Neurology Physician
- Tucson, AZ
National Provider Identifier
1104811397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 17000
- Practice address
- 1631 W Ina Rd Ste 151
Tucson, AZ 85704-1907 - Phone
- (520) 742-1833
- Fax
- (520) 742-7548
- NPI assigned
- Sep 14, 2005
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 17000 | AZ | Primary |
Addresses
Primary practice location
1631 W Ina Rd Ste 151
Tucson, AZ 85704-1907
Mailing address
1631 W Ina Rd Ste 151
Tucson, AZ 85704-1907
Phone (520) 742-1833
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 270041 | Medicaid | AZ |
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
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1104811397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 W INA RD STE 151",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857041907",
"telephone_number": "520-742-1833",
"fax_number": "520-742-7548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1631 W INA RD STE 151",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857041907",
"telephone_number": "520-742-1833",
"fax_number": "520-742-7548"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WENDT",
"first_name": "JEANETTE",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-14",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "AZ",
"license": "17000",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "270041",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.