Provider Demographics
NPI:1326028200
Name:MANETTI, WENDY G (CRNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:MANETTI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:GROCHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 MORGAN HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-558-7410
Mailing Address - Fax:
Practice Address - Street 1:231 NORTHERN BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9189
Practice Address - Country:US
Practice Address - Phone:570-587-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005804B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91027Medicare UPIN
PA032167Medicare PIN