Provider Demographics
NPI:1982847794
Name:FENN, CLAIRE CECILIA (MAOM)
Entity Type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:CECILIA
Last Name:FENN
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3713
Mailing Address - Country:US
Mailing Address - Phone:352-336-6842
Mailing Address - Fax:352-336-6842
Practice Address - Street 1:804 NE 12TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3713
Practice Address - Country:US
Practice Address - Phone:352-336-6842
Practice Address - Fax:352-336-6842
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2514171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist