Individual
CORINNE LEE WENTWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
221 W COLORADO BLVD STE 525, DALLAS, TX 75208-2312
(214) 960-5681
(214) 960-5681
Mailing address
5605 N MACARTHUR BLVD STE 740, IRVING, TX 75038-2626
(214) 960-5681
(214) 820-3558
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA02769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104345702
—
TX
01
—
P01173046
MEDICARE RAIL ROAD
TX
Enumeration date
04/25/2006
Last updated
03/25/2025
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