MEDICARE: YEHUDIS KENNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR19248500	NJ
2	367500000X	Certified Registered Nurse Anesthetist	26NR19248500	NJ

General Provider Information

NPI Number	:	1154185619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEHUDIS KENNER

Provider Business Mailing Address
First Line	:	1525 WEST CYPRESS CREEK ROAD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 WEST CYPRESS CREEK ROAD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	05/01/2024

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Directions to “ YEHUDIS KENNER ” Practice Location

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