Physician Compare National (NPI:1811954894)

HEALTHCARE PROVIDER: ELIZABETH ANN WANEK MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1811954894
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8123143260
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100914000294
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WANEK
	Individual professional last name
Provider First Name	ELIZABETH
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CREIGHTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	PREVENTATIVE MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	3817 LAWNDALE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE D1
	Group Practice or individual's line 2 address
City	GREENSBORO
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	274551641
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490075
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOVAH HEALTH DANVILLE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M