Provider Demographics
NPI:1376947309
Name:WERTZ, BROOKE EMILY (AS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:EMILY
Last Name:WERTZ
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WERTZ DR
Mailing Address - Street 2:
Mailing Address - City:DYSART
Mailing Address - State:PA
Mailing Address - Zip Code:16636-9216
Mailing Address - Country:US
Mailing Address - Phone:814-215-6606
Mailing Address - Fax:
Practice Address - Street 1:171 WERTZ DRIVE
Practice Address - Street 2:
Practice Address - City:DYSART
Practice Address - State:PA
Practice Address - Zip Code:16636
Practice Address - Country:US
Practice Address - Phone:814-215-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009948172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker