Provider Demographics
NPI:1073693875
Name:WENTZELL, JOANNE C
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:C
Last Name:WENTZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1215
Mailing Address - Country:US
Mailing Address - Phone:856-305-2889
Mailing Address - Fax:856-784-3766
Practice Address - Street 1:99 BERLIN RD
Practice Address - Street 2:
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1215
Practice Address - Country:US
Practice Address - Phone:856-305-2889
Practice Address - Fax:856-784-3766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04616200163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant