Provider Demographics
NPI:1417494030
Name:KENFIELD, LUANN JOAN
Entity Type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:JOAN
Last Name:KENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 S DEPEW ST APT C
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-8402
Mailing Address - Country:US
Mailing Address - Phone:720-244-2807
Mailing Address - Fax:
Practice Address - Street 1:7934 S DEPEW ST APT C
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-8402
Practice Address - Country:US
Practice Address - Phone:720-244-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO922154974171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
922154974OtherLICENSE NUMBER