Provider Demographics
NPI:1871905331
Name:WENTZEL, JENNIFER LINN (MD, MS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LINN
Last Name:WENTZEL
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LINN
Other - Last Name:MCGHEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 KETHLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9638
Mailing Address - Country:US
Mailing Address - Phone:405-273-5801
Mailing Address - Fax:843-692-1122
Practice Address - Street 1:3315 KETHLEY RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-9638
Practice Address - Country:US
Practice Address - Phone:405-273-5801
Practice Address - Fax:053-955-9264
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.36943 LL208600000X
OK34714208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery