Provider Demographics
NPI:1861633935
Name:CRONK, WENDY M (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:CRONK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19379 7TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7504
Mailing Address - Country:US
Mailing Address - Phone:360-394-1000
Mailing Address - Fax:360-394-1035
Practice Address - Street 1:19379 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7504
Practice Address - Country:US
Practice Address - Phone:360-394-1000
Practice Address - Fax:360-394-1035
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16071363A00000X
WAPA60600572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant