Provider Demographics
NPI:1629897707
Name:SMITH, WENDY MICHELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SPANISH TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9755
Mailing Address - Country:US
Mailing Address - Phone:970-250-8945
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4844
Practice Address - Country:US
Practice Address - Phone:970-787-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95319990163WC0400X
CO167139163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management