MEDICARE: WENDY MINER ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP011995	PA

General Provider Information

NPI Number	:	1821358177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY MINER ACNP-BC

Provider Business Mailing Address
First Line	:	821 N PENNOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 N PENNOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1715
Country	:	US
Telephone Number	:	508-274-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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