Provider Demographics
NPI:1942290747
Name:WENGER, JANE STEWART (CRNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:STEWART
Last Name:WENGER
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 1:4551 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9105
Mailing Address - Country:US
Mailing Address - Phone:717-367-6786
Mailing Address - Fax:
Practice Address - Street 1:897 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2206
Practice Address - Country:US
Practice Address - Phone:717-975-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005927-B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP005927-BMedicaid
PA586976Medicare UPIN
PASP005927-BMedicaid