Healthcare Provider Details

I. General information

NPI: 1790955342
Provider Name (Legal Business Name): CHERYL A WIECZOREK CRNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LANCASTER AVE SUITE 137 LANKENAU MED BLDG
WYNNEWOOD PA
19096-3450
US

IV. Provider business mailing address

100 E LANCASTER AVE SUITE 137 LANKENAU MED BLDG
WYNNEWOOD PA
19096-3450
US

V. Phone/Fax

Practice location:
  • Phone: 610-896-8400
  • Fax: 610-896-9652
Mailing address:
  • Phone: 610-896-8400
  • Fax: 610-896-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP009766
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: