=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346709557
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVIN L WENGERT PNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2019
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5055 E BROADWAY BLVD STE A200
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85711-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-818-8810
-----------------------------------------------------
Fax | 520-818-8847
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 17749
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85731-7749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-618-8810
-----------------------------------------------------
Fax | 520-618-8847
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 223219
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------