Provider Demographics
NPI:1568597839
Name:BLACK DORN, WENDY (CRNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BLACK DORN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SUSANNE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST, SUITE 561
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-7714
Mailing Address - Fax:610-649-0761
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:GROUND FLOOR TOLL BLDG
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-6784
Practice Address - Fax:215-481-3611
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009006363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health