Provider Demographics
NPI:1407455983
Name:KENER, MADALYN (CARE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:MADALYN
Middle Name:
Last Name:KENER
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S 600 E STE A
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-4780
Mailing Address - Country:US
Mailing Address - Phone:801-358-2031
Mailing Address - Fax:
Practice Address - Street 1:286 S 600 E STE A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-4780
Practice Address - Country:US
Practice Address - Phone:801-358-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator