Provider Demographics
NPI:1710912811
Name:EDGAR, WENDY FORREST (CRNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:FORREST
Last Name:EDGAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:FORREST
Other - Last Name:EDGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 13566
Mailing Address - Street 2:EMERGENCY PHYSICIANS OF PITTSBURGH LTD
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:565 COAL VALLEY ROAD
Practice Address - Street 2:JEFFERSON REGIONAL MEDICAL CENTER
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-469-5959
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005269B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA085354Medicare ID - Type Unspecified
595263Medicare UPIN