Provider Demographics
NPI:1215304209
Name:WURTZ, HOLLY (ND)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:WURTZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:LEE
Other - Last Name:WURTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:0S718 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1589
Mailing Address - Country:US
Mailing Address - Phone:630-715-1375
Mailing Address - Fax:
Practice Address - Street 1:0S718 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1589
Practice Address - Country:US
Practice Address - Phone:630-715-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath