Provider Demographics
NPI:1144227703
Name:WENNER, NADINE P (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:P
Last Name:WENNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3455 MAIN ST
Mailing Address - Street 2:STE 5
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1147
Mailing Address - Country:US
Mailing Address - Phone:413-733-9600
Mailing Address - Fax:413-732-6534
Practice Address - Street 1:3455 MAIN ST
Practice Address - Street 2:STE 5
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1147
Practice Address - Country:US
Practice Address - Phone:413-733-9600
Practice Address - Fax:413-732-6534
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-04-24
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Provider Licenses
StateLicense IDTaxonomies
MA71759207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT484187J597OtherCONNECTICARE
070004064OtherRAILROAD MEDICARE
MA17641OtherHEALTH NEW ENGLAND
MAWEN51739OtherBLUE CROSS BLUE SHIELD
0304209OtherUNITED HEALTH CARE
MA071759OtherTUFTS HEALTH PLANS
0304209OtherUNITED HEALTH CARE
MA071759OtherTUFTS HEALTH PLANS