| NPI | 1619384617 |
|---|---|
| Former Name | NICHOLE MARIE WENGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 71005090A) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IN 28184753A) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2021-01-19 |