Provider Demographics
NPI:1194048355
Name:WENTLEY, DAWN (CRNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:WENTLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:SPORNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4815 LIBERTY AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-4484
Mailing Address - Fax:412-578-3536
Practice Address - Street 1:4815 LIBERTY AVE STE 322
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-4484
Practice Address - Fax:412-578-3536
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA228986OtherMEDICARE
PARN508518-LOtherRN LICENSE