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1184933806
NICOLE M. WIRTZ
SPRINGFIELD, IL
NPI
1184933806
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Former Name
NICOLE M. VENVERTLOH
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: IL 085003906)
Enumeration Date
2010-09-29
Last Update Date
2020-05-19
Business Address
NICOLE M. WIRTZ PA-C
800 N 1ST ST
SPRINGFIELD, IL 62702-3719
Phone number: 217-528-7541
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Mailing Address
NICOLE M. WIRTZ PA-C
1025 S 6TH ST
SPRINGFIELD, IL 62703-2403
Phone number: 217-528-7541
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