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NPI Code Detail

MEDICARE: MRS. KELLY MAY WENBERG CSFA

MEDICARE:  MRS. KELLY MAY WENBERG  CSFA
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
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1699423111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY MAY WENBERG CSFA
Provider Business Mailing Address
First Line : 715 ILLINOIS ST
Second Line :
City : WARSAW
State : MO
Zip : 65355-3229
Country : US
Telephone Number : 660-596-5293
Fax Number :
Provider Business Practice Location Address
First Line : 1600 N 2ND ST
Second Line :
City : CLINTON
State : MO
Zip : 64735-1192
Country : US
Telephone Number : 660-890-7153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2022
Last Update Date : 03/15/2022

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Directions to “ MRS. KELLY MAY WENBERG CSFA” Practice Location

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