Provider Demographics
NPI:1528424686
Name:WRENCH, MARVIN GENE
Entity type:Individual
Prefix:
First Name:MARVIN GENE
Middle Name:
Last Name:WRENCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:M
Other - Last Name:WRENCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2307 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1725
Mailing Address - Country:US
Mailing Address - Phone:919-736-7494
Mailing Address - Fax:919-736-2923
Practice Address - Street 1:2307 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1725
Practice Address - Country:US
Practice Address - Phone:919-736-7494
Practice Address - Fax:919-736-2923
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1230237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205247657OtherSEMINOLE FL HOME OFFICE