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General NPI Number Information
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NPI Number | 1417165754
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Entity Type | Individual
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Provider Name | ANDREW C WEN L.AC.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 41125 N DAISY MOUNTAIN DR
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City | ANTHEM
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State | AZ
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Zip | 85086-4954
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Country | US
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Telephone | 623-680-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 W WHITMAN DR
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City | ANTHEM
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State | AZ
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Zip | 85086-3917
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Country | US
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Telephone | 623-680-8780
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0472
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License Number State | AZ
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