Provider Demographics
NPI:1790032795
Name:WIECLAW, WENDY LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:WIECLAW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SILER DR
Mailing Address - Street 2:
Mailing Address - City:FINLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15332-1528
Mailing Address - Country:US
Mailing Address - Phone:412-384-8510
Mailing Address - Fax:
Practice Address - Street 1:3300 SILER DR
Practice Address - Street 2:
Practice Address - City:FINLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15332-1528
Practice Address - Country:US
Practice Address - Phone:412-384-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily