Provider Demographics
NPI:1730741638
Name:TYNER, WENDY NICOLE
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:NICOLE
Last Name:TYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 C ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3949
Mailing Address - Country:US
Mailing Address - Phone:907-227-1440
Mailing Address - Fax:
Practice Address - Street 1:3380 C ST STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3949
Practice Address - Country:US
Practice Address - Phone:907-227-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)