Healthcare Provider Details

I. General information

NPI: 1588769814
Provider Name (Legal Business Name): WENDY HOBBIE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

621 CEDAR LN
VILLANOVA PA
19085-1803
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-4562
  • Fax:
Mailing address:
  • Phone: 610-581-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License NumberRN251937L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberTP001032D
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: