Provider Demographics
NPI:1588244818
Name:WENZL, JOEY
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:WENZL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 LINDELL BLVD APT 14E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3446
Mailing Address - Country:US
Mailing Address - Phone:402-926-1891
Mailing Address - Fax:
Practice Address - Street 1:3733 LINDELL BLVD APT 14E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3446
Practice Address - Country:US
Practice Address - Phone:402-926-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program