Provider Demographics
NPI:1851357420
Name:WENER, FELICE (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICE
Middle Name:
Last Name:WENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FELICE
Other - Middle Name:
Other - Last Name:VABNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2596 INTERSTATE 55
Mailing Address - Street 2:TRISTATE ADVANCED SURGERY CENTER
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364
Mailing Address - Country:US
Mailing Address - Phone:870-559-2006
Mailing Address - Fax:
Practice Address - Street 1:2596 INTERSTATE 55
Practice Address - Street 2:TRISTATE ADVANCED SURGERY CENTER
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364
Practice Address - Country:US
Practice Address - Phone:870-559-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9158207L00000X
TN35725207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3868206Medicaid
3868206Medicare ID - Type Unspecified
H47936Medicare UPIN