| Doctor Name: | LAURA R WENDZICH |
| NPI Number: | 1013319854 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA60507205 |
| Business Practice Address: | 24604 104th Ave Se Ste. 101 Kent, WA - 980305385 |
| Business Phone Number: | 2533952001 |
| Business Fax Number: | 2538528012 |
| Mailing Address: | Po Box 59028, RENTON |
| State: | WA |
| Postal Code: | 980582028 |
| Phone Number: | 4252515110 |
| Fax Number: | 4252771301 |
| NPI Enumeration Date: | 09/24/2014 |
| NPI Last Update Date: | 10/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA60507205 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |