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General NPI Number Information
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NPI Number | 1457649998
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Entity Type | Individual
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Provider Name | KENNETH T WALLENFELSZ ARNP
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Gender | Male
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 3528 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5635
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Country | US
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Telephone | 907-220-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 3528 TONGASS AVE
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City | KETCHIKAN
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State | AK
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Zip | 99901-5635
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Country | US
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Telephone | 907-220-4447
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Fax | 949-577-4111
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60207225
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60207225
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201500491NP-PP
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NURU1255
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License Number State | AK
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