Healthcare Provider Details

I. General information

NPI: 1013428002
Provider Name (Legal Business Name): KENT CHRISTIAN FENNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 PANTHER LN
NAPLES FL
34109-7874
US

IV. Provider business mailing address

215 SHUMAN BLVD
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 239-591-6604
  • Fax: 239-591-6605
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: