Healthcare Provider Details

I. General information

NPI: 1326028200
Provider Name (Legal Business Name): WENDY G MANETTI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY GROCHOWSKI

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 NORTHERN BLVD SUITE 3
SOUTH ABINGTON TOWNSHIP PA
18411-9189
US

IV. Provider business mailing address

5 MORGAN HWY SUITE 6
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-587-4113
  • Fax:
Mailing address:
  • Phone: 570-558-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP005804B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: