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General NPI Number Information
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NPI Number | 1821461435
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Entity Type | Individual
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Provider Name | NICOLE BENGEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 100 E LANCASTER AVE
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3450
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Country | US
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Telephone | 484-476-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 115 N EDGMONT ST
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City | MEDIA
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State | PA
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Zip | 19063-3013
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Country | US
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Telephone | 302-530-8813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0001032
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA057847
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License Number State | PA
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