Healthcare Provider Details

I. General information

NPI: 1730003245
Provider Name (Legal Business Name): LILLIAN WENGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MAIN ST
BLAIN PA
17006-9526
US

IV. Provider business mailing address

PO BOX 27
BLAIN PA
17006-0027
US

V. Phone/Fax

Practice location:
  • Phone: 717-503-4823
  • Fax:
Mailing address:
  • Phone: 717-503-4823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: