MEDICARE: REBECCA WENDE

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	163W00000X	Registered Nurse	836819-01	NY
2	363LF0000X	Family Nurse Practitioner	26NJ15381200	NJ
3	163W00000X	Registered Nurse	26NR22417000	NJ

General Provider Information

NPI Number	:	1912882937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WENDE

Provider Business Mailing Address
First Line	:	613 PARK AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-1905
Country	:	US
Telephone Number	:	973-672-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	613 PARK AVE
Second Line	:
City	:	EAST ORANGE
State	:	NJ
Zip	:	07017-1905
Country	:	US
Telephone Number	:	973-672-8573
Fax Number	:

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

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	12/20/2025

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Directions to “ REBECCA WENDE ” Practice Location

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