Healthcare Provider Details

I. General information

NPI: 1689347619
Provider Name (Legal Business Name): MATTHEW WRENCH SR. AGPCNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N MAIN ST STE 210
FUQUAY VARINA NC
27526-8573
US

IV. Provider business mailing address

124 TEAL LAKE DR
HOLLY SPRINGS NC
27540-8887
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-6501
  • Fax: 919-341-3043
Mailing address:
  • Phone: 919-369-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5014776
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5014776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: