Provider Demographics
NPI:1013695261
Name:FENNER, DARLENE JANE
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:JANE
Last Name:FENNER
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 1:5424 ABBEY LN SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-8114
Mailing Address - Country:US
Mailing Address - Phone:651-335-1820
Mailing Address - Fax:
Practice Address - Street 1:3050 S DELAWARE ST STE 130
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2394
Practice Address - Country:US
Practice Address - Phone:650-319-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist