Healthcare Provider Details

I. General information

NPI: 1700021789
Provider Name (Legal Business Name): WENDY MORTIMER MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 POTTSVILLE PIKE
READING PA
19605-1219
US

IV. Provider business mailing address

103 CURLEY CT
MOHNTON PA
19540-8744
US

V. Phone/Fax

Practice location:
  • Phone: 610-921-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP007258
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023203
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: