Individual
SAMANTHA WENNERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
234 CROOKED CREEK PKWY, DURHAM, NC 27713-8505
(203) 432-0092
Mailing address
PO BOX 63362, CHARLOTTE, NC 28263-3362
(919) 620-4918
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-05699
NC
363AM0700X
Medical Physician Assistant
001005699
NC
367A00000X
Advanced Practice Midwife
2183
CT
Other
Enumeration date
12/14/2008
Last updated
05/13/2019
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