MEDICARE: MARVIN GENE WRENCH

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
1	237700000X	Hearing Instrument Specialist	1230	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205247657	OTHER	NC	SEMINOLE FL HOME OFFICE

General Provider Information

NPI Number	:	1528424686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN GENE WRENCH

Provider Business Mailing Address
First Line	:	2307 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1725
Country	:	US
Telephone Number	:	919-736-7494
Fax Number	:	919-736-2923

Provider Business Practice Location Address
First Line	:	2307 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1725
Country	:	US
Telephone Number	:	919-736-7494
Fax Number	:	919-736-2923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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Directions to “ MARVIN GENE WRENCH ” Practice Location

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