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General NPI Number Information
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NPI Number | 1083753248
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Entity Type | Individual
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Provider Name | WAYNE S KENNING OTS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 215 E HAWAII AVENUE
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-463-3000
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Fax | 208-463-3034
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Provider Business Mailing Address
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Address Line | 217 W GEORGIA SUITE 115
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City | NAMPA
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State | ID
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Zip | 83686
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Country | US
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Telephone | 208-463-3000
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Fax | 208-463-3034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 971057
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License Number State | ID
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