Provider Demographics
NPI:1093760324
Name:WENTZ, JULIE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MARIE
Last Name:WENTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14330 OAKHILL PARK LN STE 200B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3407
Practice Address - Country:US
Practice Address - Phone:704-316-1265
Practice Address - Fax:704-316-1266
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2054207Q00000X
NC2013-00080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005456Medicaid
NC1093760324Medicaid
NC1093760324Medicaid
WE4183721Medicare PIN
WV3810005456Medicaid