Provider Demographics
NPI:1629200563
Name:DENNIS, WENDY LYNNE (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNNE
Last Name:DENNIS
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 1:14 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3335
Mailing Address - Country:US
Mailing Address - Phone:814-362-6962
Mailing Address - Fax:814-362-4956
Practice Address - Street 1:14 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3335
Practice Address - Country:US
Practice Address - Phone:814-362-6962
Practice Address - Fax:814-362-4956
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053946363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant