Provider Demographics
NPI:1154700052
Name:OBERDORF, WENDY (FNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:OBERDORF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:EDWARDS
Other - Last Name:OBERDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:17 TROUT LN
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17053-9423
Mailing Address - Country:US
Mailing Address - Phone:717-503-7753
Mailing Address - Fax:
Practice Address - Street 1:100 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2421
Practice Address - Country:US
Practice Address - Phone:717-218-6670
Practice Address - Fax:717-218-6671
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN297228L163W00000X
PASP015052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse