Individual
GRACE M WENZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
145 HOSPITAL AVE STE 113, DU BOIS, PA 15801
(814) 375-3722
(814) 375-3086
Mailing address
145 HOSPITAL AVE STE 113, DU BOIS, PA 15801-1463
(814) 375-3722
(814) 375-3086
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
30487
AL
207RC0000X
Cardiovascular Disease Physician
Primary
MD467098
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103629311
—
PA
01
—
808302
PTAN
PA
Enumeration date
10/12/2007
Last updated
10/22/2019
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