Individual
MR. RANDY EUGENE WENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-1416
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
24202
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/11/2020
Last updated
03/18/2021
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