MEDICARE: RACHEL ELIZABETH WENGER CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP016861	PA

General Provider Information

NPI Number	:	1568993491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELIZABETH WENGER CRNP

Provider Business Mailing Address
First Line	:	5360 LINCOLN HWY
Second Line	:	SUITE 15
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:	717-442-8981

Provider Business Practice Location Address
First Line	:	5360 LINCOLN HWY
Second Line	:	SUITE 15
City	:	GAP
State	:	PA
Zip	:	17527-9451
Country	:	US
Telephone Number	:	717-442-8111
Fax Number	:	717-442-8981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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