Provider Demographics
NPI:1669517975
Name:WREN, WILLIAM HENRY
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:WREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 GATEWAY OAKS DR
Mailing Address - Street 2:APT. #119
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3219
Mailing Address - Country:US
Mailing Address - Phone:916-531-2879
Mailing Address - Fax:
Practice Address - Street 1:2330 GLENDALE LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2454
Practice Address - Country:US
Practice Address - Phone:916-641-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator