Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | OH35058266 | OH |
NPI | 1093740045 |
---|---|
Provider Name | Margie Wenz |
First Address | Belfast, ME 04915-8792 |
Second Address | Chardon, OH 44024-7022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 30/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0744369 | (05) | OH |
E32954 | (02) |