Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | VP003318B | PA |
NPI | 1013015890 |
---|---|
Provider Name | Laurie A Wehner |
First Address | Mcmurray, PA 15317 |
Second Address | Mcmurray, PA 15317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00286724 | RR MEDICARE (01) | PA |
S49369 | (02) | |
WE998052 | BLUE SHIELD (01) | PA |