Provider Demographics
NPI:1750457107
Name:PENNER, SHARON F (CDE, RLD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:F
Last Name:PENNER
Suffix:
Gender:F
Credentials:CDE, RLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE #3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-3429
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:SUITE #209
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-293-2633
Practice Address - Fax:316-293-1866
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS562133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered