Provider Demographics
NPI:1730300583
Name:GRACE, WENDOLYN RUTHE (RN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:WENDOLYN
Middle Name:RUTHE
Last Name:GRACE
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Gender:F
Credentials:RN, CRNP
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Mailing Address - Street 1:2360 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1709
Mailing Address - Country:US
Mailing Address - Phone:215-657-6776
Mailing Address - Fax:267-913-5962
Practice Address - Street 1:2360 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-657-6776
Practice Address - Fax:267-913-5961
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP005353B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily