Provider Demographics
NPI:1851427959
Name:WENTZEL, JUDITH MAE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MAE
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6767
Mailing Address - Country:US
Mailing Address - Phone:724-452-6934
Mailing Address - Fax:
Practice Address - Street 1:114 SKYLINE LN
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-8762
Practice Address - Country:US
Practice Address - Phone:724-283-3198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003781L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist