MEDICARE: ANNA ELIZABETH NICOLE FENKER

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	106S00000X	Behavior Technician		OH

General Provider Information

NPI Number	:	1710833751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA ELIZABETH NICOLE FENKER

Provider Business Mailing Address
First Line	:	1311 MAMARONECK AVE STE 140
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-5224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 STATE ROUTE 28
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-5021
Country	:	US
Telephone Number	:	513-587-8899
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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