Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | WV EDU | WV |
NPI | 1225483571 |
---|---|
Provider Name | Dr. Kevin Hennenhoefer |
First Address | Lewisburg, WV 24901-1177 |
Second Address | Lewisburg, WV 24901-1177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2016 |
Last Update Date | 24/04/2016 |