Healthcare Provider Details

I. General information

NPI: 1568597839
Provider Name (Legal Business Name): WENDY BLACK DORN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY SUSANNE BLACK

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD GROUND FLOOR TOLL BLDG
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

100 E LANCASTER AVE MOB EAST, SUITE 561
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-6784
  • Fax: 215-481-3611
Mailing address:
  • Phone: 610-642-7714
  • Fax: 610-649-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP009006
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP009006
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: