Provider Demographics
NPI:1770777427
Name:UPDEGROVE, WENDY LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LYNN
Last Name:UPDEGROVE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:912 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7485
Mailing Address - Country:US
Mailing Address - Phone:717-272-7971
Mailing Address - Fax:717-272-1241
Practice Address - Street 1:912 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7485
Practice Address - Country:US
Practice Address - Phone:717-272-7971
Practice Address - Fax:717-272-1241
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-17
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Provider Licenses
StateLicense IDTaxonomies
PAMA053119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant