Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS005483-L | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS005483L | PA |
NPI | 1528044674 |
---|---|
Provider Name | Dr. David R. Wenner |
First Address | Harrisburg, PA 17110-9720 |
Second Address | Harrisburg, PA 17110-9720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10980830001 | (05) | PA |