Provider Demographics
NPI:1366402851
Name:WENGENDER, LYNN M (PA)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:M
Last Name:WENGENDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAGEN DR
Mailing Address - Street 2:SUITE #310
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2658
Mailing Address - Country:US
Mailing Address - Phone:585-641-0400
Mailing Address - Fax:585-641-0300
Practice Address - Street 1:30 HAGEN DR
Practice Address - Street 2:SUITE #310
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2658
Practice Address - Country:US
Practice Address - Phone:585-641-0400
Practice Address - Fax:585-641-0300
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004325363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019004325OtherBLUE CHOICE PROVIDER NO.
NY108994BJOtherPREFERRED CARE
NY108994BJOtherPREFERRED CARE
NYCC0547Medicare ID - Type Unspecified