Provider Demographics
NPI:1902487135
Name:WENDE, SARAH MARIE (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:WENDE
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:LOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:350 E WILLOW GROVE AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4416
Mailing Address - Country:US
Mailing Address - Phone:716-430-6916
Mailing Address - Fax:
Practice Address - Street 1:750 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4143
Practice Address - Country:US
Practice Address - Phone:609-394-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062387363A00000X
CT6120363A00000X
NJ25MP00612000363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1172046OtherPHYSICIAN ASSISTANT CERTIFICATION BY NCCPA
NJ25MP00612000OtherSTATE LICENSE TO PRACTICE
PAMA062387OtherSTATE LICENSE TO PRACTICE
CT6120OtherCONNECTICUT STATE LICENSE