1891308276 NPI number — JENNIFER NICOLE WURZ RDN

Table of content: JENNIFER NICOLE WURZ RDN (NPI 1891308276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891308276 NPI number — JENNIFER NICOLE WURZ RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WURZ
Provider First Name:
JENNIFER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARNETTE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891308276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 S WINTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14618-1633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-204-0725
Provider Business Mailing Address Fax Number:
585-270-6919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 S WINTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-204-0725
Provider Business Practice Location Address Fax Number:
585-270-6919
Provider Enumeration Date:
08/26/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  861506241 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)