Basic Information
| Provider Information | |||||||||
| NPI: | 1063664993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEN | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 9TH AVE | ||||||||
| Address2: | BOX 359608 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 908 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065437250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 2012-00286 | NC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD60481539 | WA | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | A112158 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.