Basic Information
| Provider Information | |||||||||
| NPI: | 1104076462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 E PALOMAR ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919131800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8851 CENTER DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194612660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 10/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 348594 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.