Healthcare Provider Details

I. General information

NPI: 1083929806
Provider Name (Legal Business Name): SUSAN JANE WERTZ RPA/RRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 7TH ST
BISMARCK ND
58501-4439
US

IV. Provider business mailing address

325 BRISTOL LN
HOLLIDAYSBURG PA
16648-2948
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6000
  • Fax:
Mailing address:
  • Phone: 814-312-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: