Provider Demographics
NPI:1366588725
Name:DICK, WENDI JOLEA (MD)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:JOLEA
Last Name:DICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12163 71ST ST SE
Mailing Address - Street 2:
Mailing Address - City:FORT RANSOM
Mailing Address - State:ND
Mailing Address - Zip Code:58033-9529
Mailing Address - Country:US
Mailing Address - Phone:303-915-9446
Mailing Address - Fax:
Practice Address - Street 1:12163 71ST ST SE
Practice Address - Street 2:
Practice Address - City:FORT RANSOM
Practice Address - State:ND
Practice Address - Zip Code:58033-9529
Practice Address - Country:US
Practice Address - Phone:303-915-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE212882083P0901X
CAA1037842083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine