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General NPI Number Information
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NPI Number | 1518291640
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Entity Type | Individual
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Provider Name | JENNIFER M WURZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 13855 E 14TH ST SAN LEANDRO HOSPITAL ED
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2611
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Country | US
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Telephone | 585-259-1052
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Fax |
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Provider Business Mailing Address
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Address Line | 24 QUAILBUSH DR
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City | FAIRPORT
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State | NY
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Zip | 14450-8936
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Country | US
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Telephone | 585-259-1052
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 013474
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21866
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License Number State | CA
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