Provider Demographics
NPI:1982390571
Name:VENTO, MCKENNA (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:VENTO
Suffix:
Gender:F
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 1:303 WOODLANDS CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2295
Mailing Address - Country:US
Mailing Address - Phone:262-366-7872
Mailing Address - Fax:
Practice Address - Street 1:3445 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4420
Practice Address - Country:US
Practice Address - Phone:773-205-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant