Provider Demographics
NPI:1689347619
Name:WRENCH, MATTHEW SR (AGPCNP-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:WRENCH
Suffix:SR
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:124 TEAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8887
Mailing Address - Country:US
Mailing Address - Phone:919-369-2439
Mailing Address - Fax:
Practice Address - Street 1:2400 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-8573
Practice Address - Country:US
Practice Address - Phone:919-235-6501
Practice Address - Fax:919-341-3043
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014776363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health