MEDICARE: MRS. KENNA LAINE WARE AP, DOM

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	171100000X	Acupuncturist	AP565	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336182856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENNA LAINE WARE AP, DOM

Provider Business Mailing Address
First Line	:	2939 WILLOW BAY TER
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-6735
Country	:	US
Telephone Number	:	407-782-1934
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 TUSKAWILLA RD STE 111
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5030
Country	:	US
Telephone Number	:	407-782-1934
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/14/2020

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