Provider Demographics
NPI:1851474449
Name:WENTZ, CHRISTI ANN (RN CRNA)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTI
Middle Name:ANN
Last Name:WENTZ
Suffix:
Gender:F
Credentials:RN CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-768-7401
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4077
Practice Address - Fax:304-388-9852
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN41909-CRNA367500000X
WV46524367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV430069479OtherE MEDICARE
WV0068695000Medicaid
WVWE7243791Medicare ID - Type Unspecified