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NPI Code Detail

MEDICARE: WENNER FAMILY MEDICINE, INC.

MEDICARE: WENNER FAMILY MEDICINE, INC.
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
1207Q00000XFamily Medicine Physician10220NV

General Provider Information

NPI Number : 1932289980
Entity Type Code : Organization
Provider Name (Legal Business Name) : WENNER FAMILY MEDICINE, INC.
Provider Business Mailing Address
First Line : 3150 N TENAYA WAY STE 135
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0463
Country : US
Telephone Number : 702-360-2088
Fax Number : 702-360-5428
Provider Business Practice Location Address
First Line : 3150 N TENAYA WAY STE 135
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0463
Country : US
Telephone Number : 702-360-2088
Fax Number : 702-360-5428
Authorized Official
Title or Position : PRESIDENT
Name : DR. LARA C WENNER
Credential : M.D.
Telephone Number : 703-360-2088
Provider Enumeration Date : 10/16/2006
Last Update Date : 08/22/2020

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Directions to “WENNER FAMILY MEDICINE, INC. ” Practice Location

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