Provider Demographics
NPI:1891308276
Name:WURZ, JENNIFER NICOLE (RDN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:WURZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:ARNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:919 S WINTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1633
Mailing Address - Country:US
Mailing Address - Phone:585-204-0725
Mailing Address - Fax:585-270-6919
Practice Address - Street 1:919 S WINTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1633
Practice Address - Country:US
Practice Address - Phone:585-204-0725
Practice Address - Fax:585-270-6919
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY861506241133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty