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General NPI Number Information
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NPI Number | 1215563135
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Entity Type | Individual
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Provider Name | JESSICA LOUISE WENZEL MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 3112
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City | MERIDIAN
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State | ID
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Zip | 83642-6352
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Country | US
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Telephone | 208-706-5800
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Fax | 208-706-5810
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2971839
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License Number State | ID
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