Provider Demographics
NPI:1811267909
Name:WENGER, ANGEL LOUISE (PA-C)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LOUISE
Last Name:WENGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N TENAYA WAY STE 290
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1406
Mailing Address - Country:US
Mailing Address - Phone:702-420-2163
Mailing Address - Fax:702-420-2930
Practice Address - Street 1:2701 N TENAYA WAY STE 290
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1406
Practice Address - Country:US
Practice Address - Phone:702-420-2163
Practice Address - Fax:702-420-2930
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1319363A00000X
NVPA0473363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant