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NPI Code Detail

MEDICARE: MARTINE ELIZABETH WURST PA-C

MEDICARE:   MARTINE ELIZABETH WURST  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 Assistant102599NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1801892807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTINE ELIZABETH WURST PA-C
Provider Business Mailing Address
First Line : 200 E 2ND AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4358
Country : US
Telephone Number : 704-874-1900
Fax Number :
Provider Business Practice Location Address
First Line : 991 W HUDSON BLVD
Second Line :
City : GASTONIA
State : NC
Zip : 28052-6430
Country : US
Telephone Number : 704-852-5294
Fax Number : 704-862-5383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 11/05/2019

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Directions to “ MARTINE ELIZABETH WURST PA-C” Practice Location

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