Provider Demographics
NPI:1518172899
Name:WENGER, DORIS (CRNP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:WENGER
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 1:495 HIGHLANDS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320
Mailing Address - Country:US
Mailing Address - Phone:610-384-9500
Mailing Address - Fax:610-384-3998
Practice Address - Street 1:495 HIGHLANDS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320
Practice Address - Country:US
Practice Address - Phone:610-384-9500
Practice Address - Fax:610-384-3998
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001911D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVP001911DOtherCRNP LICENSE
PARN193094LOtherRN LICENSE
PA005397OtherPRESCRIPTION AUTH