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General NPI Number Information
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NPI Number | 1992915623
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Entity Type | Individual
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Provider Name | DALIA JEANETTE WENCKUS MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 501 19TH ST STE 401
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City | KNOXVILLE
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State | TN
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Zip | 37916-1831
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Country | US
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Telephone | 865-331-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 501 19TH ST STE 401
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City | KNOXVILLE
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State | TN
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Zip | 37916-1831
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Country | US
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Telephone | 865-331-2020
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | DR.0064268
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 40862
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 35.126718
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 01063635A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 72651
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License Number State | TN
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