Healthcare Provider Details

I. General information

NPI: 1689815011
Provider Name (Legal Business Name): DEBORAH B WURZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2009
Last Update Date: 03/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 SUNSET AVE
UTICA NY
13502-5710
US

IV. Provider business mailing address

2210 SUNSET AVE
UTICA NY
13502-5710
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-2511
  • Fax:
Mailing address:
  • Phone: 315-724-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4476691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: