Healthcare Provider Details

I. General information

NPI: 1235073404
Provider Name (Legal Business Name): MIRANDA KATE WENGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 NEW HOLLAND PIKE
LANCASTER PA
17601-5935
US

IV. Provider business mailing address

1318 WOODLAND CIR
DENVER PA
17517-9761
US

V. Phone/Fax

Practice location:
  • Phone: 717-617-0092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN783915
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: