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General NPI Number Information
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NPI Number | 1134130396
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Entity Type | Individual
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Provider Name | WENDY L KENNER PA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 2551 W 84TH AVE
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City | WESTMINSTER
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State | CO
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Zip | 80031-3807
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Country | US
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Telephone | 720-255-2953
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1802
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City | BERTHOUD
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State | CO
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Zip | 80513-1802
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Country | US
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Telephone | 720-255-2953
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2199
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License Number State | CO
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