Provider Demographics
NPI:1235553884
Name:WENCEL, ALINA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:WENCEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALINA
Other - Middle Name:
Other - Last Name:REBYAKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6182
Practice Address - Fax:440-835-6183
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100356Medicaid
OHH295790Medicare PIN