Provider Demographics
NPI:1487313425
Name:WIRZ, JEANETTE JEANETTE
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:JEANETTE
Last Name:WIRZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 BOB WHITE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-5112
Mailing Address - Country:US
Mailing Address - Phone:615-400-2780
Mailing Address - Fax:
Practice Address - Street 1:8327 SAWYER BROWN RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2539
Practice Address - Country:US
Practice Address - Phone:615-400-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210527246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty