Healthcare Provider Details

I. General information

NPI: 1003212879
Provider Name (Legal Business Name): ADAM CHRISTOPHER WENNER CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

3968 SOMBRA ARBOL CT
LAS CRUCES NM
88012-0733
US

V. Phone/Fax

Practice location:
  • Phone: 469-303-7000
  • Fax:
Mailing address:
  • Phone: 575-649-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP126830
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: