Provider Demographics
NPI:1518291640
Name:WURZ, JENNIFER M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:WURZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 QUAILBUSH DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8936
Mailing Address - Country:US
Mailing Address - Phone:585-259-1052
Mailing Address - Fax:
Practice Address - Street 1:13855 E 14TH ST
Practice Address - Street 2:SAN LEANDRO HOSPITAL ED
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2611
Practice Address - Country:US
Practice Address - Phone:585-259-1052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013474363A00000X
CAPA21866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant