Individual
ELENA WURTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, PNP-AC
Contact information
Practice address
7777 FOREST LN STE C300, DALLAS, TX 75230-2514
(972) 401-8794
Mailing address
8423 FLOWER MEADOW DR., DALLAS, TX 75243
(972) 401-8794
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
656517
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205894301
—
TX
01
—
P00729264
RAILROAD MEDICARE PTAN
TX
Enumeration date
03/12/2009
Last updated
12/30/2009
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