Provider Demographics
NPI:1316306210
Name:WENGER, JANET MARIE (CNP)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:MARIE
Last Name:WENGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JANET, JANET
Other - Middle Name:M
Other - Last Name:SANCHEZ, O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:1100 LEAD AVE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-5215
Practice Address - Country:US
Practice Address - Phone:740-282-9093
Practice Address - Fax:740-282-9087
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18960363LF0000X
WV109015363LP0808X
NMCNP-03134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161305Medicaid
NM46833269Medicaid
OHH442920Medicare PIN