Provider Demographics
NPI:1396084612
Name:WENTZELL, JULIE C (LPN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:WENTZELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W EVERETT ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:FALCONER
Mailing Address - State:NY
Mailing Address - Zip Code:14733-1647
Mailing Address - Country:US
Mailing Address - Phone:716-969-5216
Mailing Address - Fax:
Practice Address - Street 1:407 W EVERETT ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-1647
Practice Address - Country:US
Practice Address - Phone:716-969-5216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313032-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse