Individual
WENDELL WARREN WENNEKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3443 VILLA LN, SUITE 3, NAPA, CA 94558-6417
(707) 226-2031
(707) 252-1087
Mailing address
3443 VILLA LN, SUITE 3, NAPA, CA 94558-6417
(707) 226-2031
(707) 252-1087
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G37197
CA
2086S0129X
Vascular Surgery Physician
G37197
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G371970
BLUE SHIELD
CA
05
—
00G371970
—
CA
Enumeration date
08/03/2006
Last updated
03/16/2009
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