Provider Demographics
NPI:1932289980
Name:WENNER FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:WENNER FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-360-2088
Mailing Address - Street 1:3150 N TENAYA WAY STE 135
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0463
Mailing Address - Country:US
Mailing Address - Phone:702-360-2088
Mailing Address - Fax:702-360-5428
Practice Address - Street 1:3150 N TENAYA WAY STE 135
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0463
Practice Address - Country:US
Practice Address - Phone:702-360-2088
Practice Address - Fax:702-360-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty