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General NPI Number Information
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NPI Number | 1982681094
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Entity Type | Individual
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Provider Name | RANDY L WIRTZ ARNP
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 160 E MAIN ST
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City | DENVER
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State | IA
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Zip | 50622-9612
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Country | US
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Telephone | 319-984-5645
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Fax | 319-984-5364
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Provider Business Mailing Address
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Address Line | 160 E MAIN ST
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City | DENVER
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State | IA
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Zip | 50622-9612
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Country | US
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Telephone | 319-984-5645
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Fax | 319-984-5364
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A056327
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License Number State | IA
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