Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO60122640 | WA |
N | 222Z00000X | Podiatrist | PO60122640 | WA |
N | 213EP1101X | Primary Podiatric Medicine | PO60122640 | WA |
N | 111NR0200X | Radiology | PO60122640 | WA |
N | 213ER0200X | Radiology | PO60122640 | WA |
N | 2081S0010X | Sports Medicine | PO60122640 | WA |
N | 213ES0000X | Sports Medicine | PO60122640 | WA |
Y | 213ES0103X | Foot & Ankle Surgery | PO60122640 | WA |
N | 213ES0131X | Foot Surgery | PO60122640 | WA |
NPI | 1205152576 |
---|---|
Provider Name | Ellen Mercedes Wenzel |
First Address | Vancouver, WA 98683-5297 |
Second Address | Vancouver, WA 98683-5297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2010 |
Last Update Date | 12/05/2020 |