Provider Demographics
NPI:1760763213
Name:WENZEL, STACY MILLER (CRNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:MILLER
Last Name:WENZEL
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 1:1030 NEW HOLLAND AVENUE
Mailing Address - Street 2:BLDG 12A SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5690
Mailing Address - Country:US
Mailing Address - Phone:717-544-9400
Mailing Address - Fax:717-544-9401
Practice Address - Street 1:2102 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-9400
Practice Address - Fax:717-544-9401
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily