Provider Demographics
NPI:1871869628
Name:WENTZEL, CHRISTINA LOUISE (RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:425 HENRY ST
Mailing Address - Street 2:#104 NURSE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6010
Mailing Address - Country:US
Mailing Address - Phone:718-330-1217
Mailing Address - Fax:718-596-4989
Practice Address - Street 1:425 HENRY ST
Practice Address - Street 2:#104 NURSE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6010
Practice Address - Country:US
Practice Address - Phone:718-330-1217
Practice Address - Fax:718-596-4989
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543106163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool