| Doctor Name: | WILLIAM WENSTROM |
| NPI Number: | 1013170653 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ACNP |
| License Number: | R851481 |
| Business Practice Address: | 10319 Diberville Blvd Diberville, MS - 395402506 |
| Business Phone Number: | 2283962113 |
| Business Fax Number: | |
| Mailing Address: | 2101 Highway 90, GAUTIER |
| State: | MS |
| Postal Code: | 395535340 |
| Phone Number: | 2283962999 |
| Fax Number: | |
| NPI Enumeration Date: | 07/03/2008 |
| NPI Last Update Date: | 07/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R851481 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |