Provider Demographics
NPI:1497901318
Name:FENNER, PAUL BRIAN (RN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRIAN
Last Name:FENNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DELEVAN AVE
Mailing Address - Street 2:
Mailing Address - City:DELEVAN
Mailing Address - State:NY
Mailing Address - Zip Code:14042
Mailing Address - Country:US
Mailing Address - Phone:716-492-3886
Mailing Address - Fax:
Practice Address - Street 1:65 DELEVAN AVE
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042
Practice Address - Country:US
Practice Address - Phone:716-492-3886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse