Provider Demographics
NPI:1255592150
Name:VENNER, ALLISON WALTER (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:WALTER
Last Name:VENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 VISTA LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4643
Mailing Address - Country:US
Mailing Address - Phone:775-884-4567
Mailing Address - Fax:775-884-4569
Practice Address - Street 1:6360 S 3000 E STE 220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6924
Practice Address - Country:US
Practice Address - Phone:801-944-3144
Practice Address - Fax:801-944-3186
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038966207R00000X
NV15528207RG0100X
UT13090962-1205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine