Provider Demographics
NPI:1083864714
Name:VENNEMAN, STEPHEN FREDERICK (LMT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:FREDERICK
Last Name:VENNEMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66496
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6496
Mailing Address - Country:US
Mailing Address - Phone:505-307-5818
Mailing Address - Fax:
Practice Address - Street 1:105 4TH ST. SW
Practice Address - Street 2:SUITE # 16
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-307-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6083174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist