Healthcare Provider Details

I. General information

NPI: 1568993491
Provider Name (Legal Business Name): RACHEL ELIZABETH WENGER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 LINCOLN HWY SUITE 15
GAP PA
17527-9451
US

IV. Provider business mailing address

5360 LINCOLN HWY SUITE 15
GAP PA
17527-9451
US

V. Phone/Fax

Practice location:
  • Phone: 717-442-8111
  • Fax: 717-442-8981
Mailing address:
  • Phone: 717-442-8111
  • Fax: 717-442-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: