Provider Demographics
NPI:1811689714
Name:WENGER, LORESSA KATHRYN (DNP, APRN FNP-C)
Entity type:Individual
Prefix:DR
First Name:LORESSA
Middle Name:KATHRYN
Last Name:WENGER
Suffix:
Gender:F
Credentials:DNP, APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PETERSON PL APT 33C
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5347
Mailing Address - Country:US
Mailing Address - Phone:732-330-0526
Mailing Address - Fax:
Practice Address - Street 1:2700 PETERSON PL APT 33C
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5347
Practice Address - Country:US
Practice Address - Phone:732-330-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily