Provider Demographics
NPI:1033743174
Name:VANNOSTRAND, KENDALL MCKINLEY (DOM)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MCKINLEY
Last Name:VANNOSTRAND
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:TESUQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87574-0038
Mailing Address - Country:US
Mailing Address - Phone:505-819-1106
Mailing Address - Fax:
Practice Address - Street 1:805 EARLY ST STE B102
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1707
Practice Address - Country:US
Practice Address - Phone:505-216-1119
Practice Address - Fax:505-349-4748
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1245171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty