Most Relevant Information
Provider Data
| NPI Number: | 1003351206 |
| Provider Name: | WENDY LYNN BROCK NNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 114762 |
Most Important Dates
| Enumeration Date: | 12/23/2016 |
| Last Updated: | 12/23/2016 |
Provider Practice Location
1638 OWEN DR
FAYETTEVILLE
NC
283043424
Practice Location Phone/Fax
| Phone: | 9106155490 |
| Fax: |
Provider Mailing Location
PO BOX 40908
FAYETTEVILLE
NC
283090908
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |