Provider Demographics
NPI:1346709557
Name:WENGERT, DEVIN L (PNP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:L
Last Name:WENGERT
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17749
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85731-7749
Mailing Address - Country:US
Mailing Address - Phone:520-618-8810
Mailing Address - Fax:520-618-8847
Practice Address - Street 1:5055 E BROADWAY BLVD STE A200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3649
Practice Address - Country:US
Practice Address - Phone:520-818-8810
Practice Address - Fax:520-818-8847
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223219363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223219OtherARIZONA BOARD OF NURSING