Provider Demographics
NPI:1760729024
Name:WENNERLIND, KARMANN LYNETTE (MED)
Entity Type:Individual
Prefix:
First Name:KARMANN
Middle Name:LYNETTE
Last Name:WENNERLIND
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 W AZURE DR STE 245
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4416
Mailing Address - Country:US
Mailing Address - Phone:702-595-5437
Mailing Address - Fax:
Practice Address - Street 1:7495 W. AZURE DR
Practice Address - Street 2:STE 245
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130
Practice Address - Country:US
Practice Address - Phone:702-595-5437
Practice Address - Fax:702-425-2787
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV92543251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management