Provider Demographics
NPI:1467496588
Name:WRENCHER, STEPHANIE NICOLE (PA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:WRENCHER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8030
Mailing Address - Country:US
Mailing Address - Phone:510-350-2777
Mailing Address - Fax:
Practice Address - Street 1:771 OLD NORCROSS RD STE 255
Practice Address - Street 2:NORTHSIDE GWINNETT PRIMARY CARE
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-963-2967
Practice Address - Fax:770-339-4585
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-04-26
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Provider Licenses
StateLicense IDTaxonomies
CA003273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS74252Medicare UPIN