Provider Demographics
NPI:1023518677
Name:BEALLA, WENDY
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:BEALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:ECKENRODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1155 E MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7906
Mailing Address - Country:US
Mailing Address - Phone:570-808-7916
Mailing Address - Fax:
Practice Address - Street 1:1155 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-808-7916
Practice Address - Fax:570-808-6006
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN539188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse