Provider Demographics
NPI:1457676777
Name:WENTZ, CAROL O (RN, MASSAGE THERAPIS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:O
Last Name:WENTZ
Suffix:
Gender:F
Credentials:RN, MASSAGE THERAPIS
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:O
Other - Last Name:WENTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:NEW BERLINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19545-0339
Mailing Address - Country:US
Mailing Address - Phone:610-256-9297
Mailing Address - Fax:
Practice Address - Street 1:253 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-1641
Practice Address - Country:US
Practice Address - Phone:610-256-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254548L163WM1400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse