Provider Demographics
NPI:1912135856
Name:MAHONEY, WENDY A (RN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:A
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LANCASTER AVE
Mailing Address - Street 2:STUDENT HEALTH SERVICES
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1336
Mailing Address - Country:US
Mailing Address - Phone:610-896-1089
Mailing Address - Fax:
Practice Address - Street 1:370 LANCASTER AVE
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1336
Practice Address - Country:US
Practice Address - Phone:610-896-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-305603-L363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily