Provider Demographics
NPI:1336169374
Name:TEMMEN, WAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:TEMMEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0656
Mailing Address - Country:US
Mailing Address - Phone:802-254-9441
Mailing Address - Fax:802-254-3233
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:KEENE CLINIC CHESHIRE MEDICAL CTR
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00019611OtherBC/VT
VT00019611OtherBC/VT
S31415Medicare UPIN