Basic Information
| Provider Information | |||||||||
| NPI: | 1578061800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERTZ | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LEATHERS | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 217 CALDWELL ST | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283901753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023197092 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2460 CURTIS ELLIS DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529628000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 5815 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.