MEDICARE: LORI WENZ NP

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	363LF0000X	Family Nurse Practitioner	839807	CA
2	363L00000X	Nurse Practitioner	NP95001728	CA

General Provider Information

NPI Number	:	1679961783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI WENZ NP

Provider Business Mailing Address
First Line	:	2820 VESTRELLA DR
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-9377
Country	:	US
Telephone Number	:	209-505-9399
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 GRAND AVE STE 302
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2694
Country	:	US
Telephone Number	:	970-773-5777
Fax Number	:

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

Provider Enumeration Date	:	12/26/2014
Last Update Date	:	08/09/2023

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