Provider Demographics
NPI:1831517952
Name:KENNER, PAULA NADINE (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:NADINE
Last Name:KENNER
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:NADINE
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 ENGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4223
Mailing Address - Country:US
Mailing Address - Phone:215-800-5538
Mailing Address - Fax:
Practice Address - Street 1:1316 ENGLEWOOD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4223
Practice Address - Country:US
Practice Address - Phone:215-800-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACO2688971744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management