Provider Demographics
NPI:1124485560
Name:JAWORSKI, WENDELIN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:WENDELIN
Middle Name:
Last Name:JAWORSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434
Mailing Address - Country:US
Mailing Address - Phone:814-654-7334
Mailing Address - Fax:814-654-6867
Practice Address - Street 1:132 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434
Practice Address - Country:US
Practice Address - Phone:814-654-7334
Practice Address - Fax:814-654-6867
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner