Healthcare Provider Details

I. General information

NPI: 1154700052
Provider Name (Legal Business Name): WENDY OBERDORF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY EDWARDS OBERDORF RN

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HANOVER ST
CARLISLE PA
17013-2421
US

IV. Provider business mailing address

17 TROUT LN
MARYSVILLE PA
17053-9423
US

V. Phone/Fax

Practice location:
  • Phone: 717-218-6670
  • Fax: 717-218-6671
Mailing address:
  • Phone: 717-503-7753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015052
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN297228L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: