Provider Demographics
NPI:1588212245
Name:LENKNER, DYLAN ROBERT
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:ROBERT
Last Name:LENKNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21845 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:CA
Mailing Address - Zip Code:96059-9324
Mailing Address - Country:US
Mailing Address - Phone:530-474-1647
Mailing Address - Fax:
Practice Address - Street 1:748 N MARKET ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3606
Practice Address - Country:US
Practice Address - Phone:530-338-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program