Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 07000900A | IN |
NPI | 1407841463 |
---|---|
Provider Name | Wendy K Kennedy |
First Address | Terre Haute, IN 47803-0402 |
Second Address | Terre Haute, IN 47807-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U81113 | (02) |