Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS018047 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | OS018047 | PA |
NPI | 1164866091 |
---|---|
Provider Name | Dr. Ryan Christopher Wennell |
First Address | Lancaster, PA 17601-4207 |
Second Address | Lancaster, PA 17601-4207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2013 |
Last Update Date | 09/01/2020 |