Provider Demographics
NPI:1609631332
Name:VENZKE, KENDRA LEE
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEE
Last Name:VENZKE
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 1:2254 MIDDLEBURY DR
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8473
Mailing Address - Country:US
Mailing Address - Phone:770-309-9681
Mailing Address - Fax:
Practice Address - Street 1:2254 MIDDLEBURY DR
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8473
Practice Address - Country:US
Practice Address - Phone:770-309-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)