Provider Demographics
NPI:1649436098
Name:WENGER, RACHEL MARIE (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:WENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S CLAY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:IL
Mailing Address - Zip Code:61739-1481
Mailing Address - Country:US
Mailing Address - Phone:815-692-1150
Mailing Address - Fax:815-692-1153
Practice Address - Street 1:401 S CLAY ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:IL
Practice Address - Zip Code:61739-1481
Practice Address - Country:US
Practice Address - Phone:815-692-1150
Practice Address - Fax:815-692-1153
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013850A207Q00000X
IL036124753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine