Provider Demographics
NPI:1598713844
Name:WENGER, LINDA S (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:WENGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ELMWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4021
Mailing Address - Country:US
Mailing Address - Phone:717-575-9198
Mailing Address - Fax:
Practice Address - Street 1:3045 MARIETTA AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1321
Practice Address - Country:US
Practice Address - Phone:717-898-2900
Practice Address - Fax:717-898-3275
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP94363Medicare UPIN