Provider Demographics
NPI:1003814765
Name:HARGROVE, WENDE DENISE (FNP)
Entity Type:Individual
Prefix:MS
First Name:WENDE
Middle Name:DENISE
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WENDE
Other - Middle Name:D
Other - Last Name:FORTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 SIERRA COLLEGE BLVD
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3855
Mailing Address - Country:US
Mailing Address - Phone:916-660-7490
Mailing Address - Fax:
Practice Address - Street 1:5100 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3855
Practice Address - Country:US
Practice Address - Phone:916-660-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily