Basic Information
Provider Information | |||||||||
NPI: | 1831478437 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STRINGER | ||||||||
FirstName: | WENDEE | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ATP4542 | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | JUKKOLA | ||||||||
OtherFirstName: | WENDEE | ||||||||
OtherMiddleName: | L | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 211 S. STEMMONS FRWY, #F | ||||||||
Address2: |   | ||||||||
City: | LEWISVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 75029 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9724341700 | ||||||||
FaxNumber: | 9722210099 | ||||||||
Practice Location | |||||||||
Address1: | 211 S. STEMMONS FRWY, #F | ||||||||
Address2: |   | ||||||||
City: | LEWISVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 75029 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9724341700 | ||||||||
FaxNumber: | 9722210099 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2011 | ||||||||
LastUpdateDate: | 11/16/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | ATP4542 | TX | Y |   | Technologists, Technicians & Other Technical Service Providers | Technician, Other |   |
No ID Information.