Healthcare Provider Details

I. General information

NPI: 1316306210
Provider Name (Legal Business Name): JANET MARIE WENGER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET, JANET M SANCHEZ, O'BRIEN

II. Dates (important events)

Enumeration Date: 02/19/2016
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LEAD AVE
ALBUQUERQUE NM
87106-5215
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-9093
  • Fax: 740-282-9087
Mailing address:
  • Phone: 505-923-6770
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18960
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number109015
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: