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General NPI Number Information
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NPI Number | 1780933077
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Entity Type | Individual
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Provider Name | LISA KENNER
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Gender | Female
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 09/03/2012
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Provider Practice Location Address
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Address Line | 8580 SCARBOROUGH DR SUITE 125
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7583
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Country | US
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Telephone | 719-282-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 8076 FALLGOLD CT
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City | COLORADO SPRINGS
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State | CO
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Zip | 80927-5001
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Country | US
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Telephone |
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number |
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License Number State |
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