Provider Demographics
NPI:1427338177
Name:KENNER, TAMMY SCHULTZ
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SCHULTZ
Last Name:KENNER
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 1:4465 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55987-1659
Mailing Address - Country:US
Mailing Address - Phone:507-410-1144
Mailing Address - Fax:507-410-1144
Practice Address - Street 1:4465 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:GOODVIEW
Practice Address - State:MN
Practice Address - Zip Code:55987-1659
Practice Address - Country:US
Practice Address - Phone:507-410-1144
Practice Address - Fax:507-410-1144
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist