| Doctor Name: | NELLA WENNBERG |
| NPI Number: | 1144310673 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 055-0030573 |
| Business Practice Address: | 555 Washington Hwy Morrisville, VT - 056618972 |
| Business Phone Number: | 8028888405 |
| Business Fax Number: | |
| Mailing Address: | 297 Ruby Raymond Rd, WATERBURY CENTER |
| State: | VT |
| Postal Code: | 056778087 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2006 |
| NPI Last Update Date: | 07/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 055-0030573 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |