Provider Demographics
NPI:1184040487
Name:WANGA, KEVIN (CRNP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WANGA
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 HEATHERTON DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3979
Mailing Address - Country:US
Mailing Address - Phone:717-341-7645
Mailing Address - Fax:
Practice Address - Street 1:2500 LISBURN RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-8005
Practice Address - Country:US
Practice Address - Phone:717-737-4531
Practice Address - Fax:717-731-1007
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN653205163W00000X
PASP016803363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse