Healthcare Provider Details

I. General information

NPI: 1902940927
Provider Name (Legal Business Name): MARSHA ANNE WURTZ MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 N BROAD ST
PHILADELPHIA PA
19140-4160
US

IV. Provider business mailing address

SHRINERS HOSPITAL FOR CHILDREN PHILADELPHIA LOCKBOX #7642 - PO BOX 8500
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-430-4022
  • Fax: 215-430-4079
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP000430B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: