Provider Demographics
NPI:1902870918
Name:WENDT, MARION G (NP)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:G
Last Name:WENDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7751 BYRON CENTER AVE SW
Practice Address - Street 2:SUITE C
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8001
Practice Address - Country:US
Practice Address - Phone:616-267-7668
Practice Address - Fax:616-356-1941
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704223755363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4780026Medicaid
MI4780044Medicaid
MI4780071Medicaid
MI4780053Medicaid
MI4780062Medicaid
MI5008705490OtherBCBSM
MI4780035Medicaid
MI4780062Medicaid
MI4780053Medicaid