Healthcare Provider Details

I. General information

NPI: 1487564340
Provider Name (Legal Business Name): DYLAN HUNTER ORRIS WENTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W 26TH ST
ERIE PA
16508-1402
US

IV. Provider business mailing address

1330 W 26TH ST
ERIE PA
16508-1402
US

V. Phone/Fax

Practice location:
  • Phone: 814-459-9300
  • Fax: 814-456-5145
Mailing address:
  • Phone: 814-459-9300
  • Fax: 814-456-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: