Provider Demographics
NPI:1235673286
Name:WENTZEL, EMILY (CRNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BLAIR MILL RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2223
Mailing Address - Country:US
Mailing Address - Phone:717-371-5461
Mailing Address - Fax:877-383-8544
Practice Address - Street 1:680 BLAIR MILL RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2223
Practice Address - Country:US
Practice Address - Phone:717-371-5461
Practice Address - Fax:877-383-8544
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1235673286Medicaid