Provider Demographics
NPI:1366580201
Name:SURA, WENDY ADELINE (NP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ADELINE
Last Name:SURA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 EMBARCADERO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3318
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:650-843-0263
Practice Address - Street 1:50 E HAMILTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0251
Practice Address - Country:US
Practice Address - Phone:408-376-2300
Practice Address - Fax:408-376-2316
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16006363L00000X
CARN484358363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner