Healthcare Provider Details

I. General information

NPI: 1558709931
Provider Name (Legal Business Name): ANDREA CLARKE WURZER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA N CLARKE

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 3RD AVE SW
TAYLORSVILLE NC
28681-4180
US

IV. Provider business mailing address

PO BOX 1845
STATESVILLE NC
28687-1845
US

V. Phone/Fax

Practice location:
  • Phone: 704-871-2163
  • Fax: 980-829-0484
Mailing address:
  • Phone: 704-873-4277
  • Fax: 704-978-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015-01680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: