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NPI Code Detail

MEDICARE: MISS LOGANNE B WERTZ PA-C

MEDICARE: MISS LOGANNE B WERTZ PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1497362438
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LOGANNE B WERTZ PA-C
Provider Business Mailing Address
First Line : 905 E 10TH ST
Second Line :
City : FOWLER
State : IN
Zip : 47944-1620
Country : US
Telephone Number : 574-870-9659
Fax Number :
Provider Business Practice Location Address
First Line : 1429 N 6TH ST
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47807-1019
Country : US
Telephone Number : 812-242-3390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2020
Last Update Date : 03/23/2026

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Directions to “ MISS LOGANNE B WERTZ PA-C” Practice Location

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