Healthcare Provider Details

I. General information

NPI: 1558148379
Provider Name (Legal Business Name): WENDY GUZENSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 3RD AVE
KINGSTON PA
18704-5802
US

IV. Provider business mailing address

451 3RD AVE
KINGSTON PA
18704-5802
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-6543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: