Provider Demographics
NPI:1215485560
Name:TENNER, KANETHA
Entity type:Individual
Prefix:
First Name:KANETHA
Middle Name:
Last Name:TENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 9222
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8444
Mailing Address - Country:US
Mailing Address - Phone:630-728-4988
Mailing Address - Fax:
Practice Address - Street 1:2817 LEDGESTONE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8444
Practice Address - Country:US
Practice Address - Phone:630-728-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver