Basic Information
| Provider Information | |||||||||
| NPI: | 1144318585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WENTRCEK | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | LORENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WENTRCEK | ||||||||
| OtherFirstName: | PEGGY | ||||||||
| OtherMiddleName: | LORENE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2673 PINE TRAIL DR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ELM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750686857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146748033 | ||||||||
| FaxNumber: | 2146748033 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 TRADITION TRL | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143582300 | ||||||||
| FaxNumber: | 2143666127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 04/15/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 574115 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.