Provider Demographics
NPI:1952064008
Name:WEDGE, LYNDA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:MARIE
Last Name:WEDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-2745
Mailing Address - Country:US
Mailing Address - Phone:814-421-2404
Mailing Address - Fax:
Practice Address - Street 1:2165 WILLIAM PENN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1322
Practice Address - Country:US
Practice Address - Phone:814-421-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN280522L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse