Individual
JOHNNY WADE NANTZ II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
809 N 19TH ST, MIDDLESBORO, KY 40965
(606) 248-3042
Mailing address
134 SILK STOCKING RD, WALLINS CREEK, KY 40873-8963
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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