Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2011-00547 | NC |
Y | 207PP0204X | Pediatric Emergency Physician | 31019 | SC |
NPI | 1366603235 |
---|---|
Provider Name | Derick M Wenning |
First Address | Greenville, SC 29601-2842 |
Second Address | Lexington, NC 27292-6792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5919684 | (05) | NC |