Individual
MR. PAUL WERTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN-BSN
Contact information
Practice address
233 MAIN STREET, SUITE C., SAN LUIS, CO 81152-8115
(719) 672-3465
Mailing address
PO BOX 99, SAN LUIS, CO 81152-0099
(719) 672-3465
(719) 672-3856
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1616934
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000190429
—
CO
Enumeration date
12/18/2017
Last updated
07/26/2021
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