Provider Demographics
NPI:1124681242
Name:WENKE, JONATHON CHARLES (FNP)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:CHARLES
Last Name:WENKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 E ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2631
Mailing Address - Country:US
Mailing Address - Phone:631-625-7210
Mailing Address - Fax:631-866-8150
Practice Address - Street 1:375 E MAIN ST STE 26
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8418
Practice Address - Country:US
Practice Address - Phone:631-891-6200
Practice Address - Fax:631-350-7803
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY344101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily