Provider Demographics
NPI:1538886338
Name:WENGLER, NOAH K K
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:K K
Last Name:WENGLER
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 1:17-400 IPUAIWAHA ST
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-8216
Mailing Address - Country:US
Mailing Address - Phone:808-348-4238
Mailing Address - Fax:
Practice Address - Street 1:17-400 IPUAIWAHA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8216
Practice Address - Country:US
Practice Address - Phone:808-348-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician