=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043246184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY WAKEFIELD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 03/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 COAL VALLEY RD SUITE EG-01
-----------------------------------------------------
City | CLAIRTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15025-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-267-6255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 COAL VALLEY RD SUITE EG-01
-----------------------------------------------------
City | CLAIRTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15025-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP008314
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------