Provider Demographics
NPI:1518708064
Name:WENGER, JENNIFER LEE (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:WENGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 VALLEY QUAIL BLVD N
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3734
Mailing Address - Country:US
Mailing Address - Phone:614-325-3547
Mailing Address - Fax:
Practice Address - Street 1:444 N CLEVELAND AVE STE 320
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8388
Practice Address - Country:US
Practice Address - Phone:614-839-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily