Healthcare Provider Details

I. General information

NPI: 1477999035
Provider Name (Legal Business Name): WENDY MICHELLE ENNEKING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S WINTER ST
MIDWAY KY
40347-5002
US

IV. Provider business mailing address

129 S WINTER ST
MIDWAY KY
40347-5002
US

V. Phone/Fax

Practice location:
  • Phone: 859-846-4445
  • Fax:
Mailing address:
  • Phone: 859-846-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3008053
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: