Provider Demographics
NPI:1114406840
Name:WENGER, NATALIE ANNE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:WENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4921
Mailing Address - Country:US
Mailing Address - Phone:785-764-0420
Mailing Address - Fax:
Practice Address - Street 1:2630 SE CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1709
Practice Address - Country:US
Practice Address - Phone:785-379-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-16488OtherSTATE LICENSE NUMBER