Provider Demographics
NPI:1124238548
Name:WENCK, PATIENCE (FNP)
Entity type:Individual
Prefix:MS
First Name:PATIENCE
Middle Name:
Last Name:WENCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6288
Mailing Address - Country:US
Mailing Address - Phone:530-542-4961
Mailing Address - Fax:530-542-4964
Practice Address - Street 1:1154 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6288
Practice Address - Country:US
Practice Address - Phone:530-542-4961
Practice Address - Fax:530-542-4964
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5903363LF0000X
NVAPN00263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily