Provider Demographics
NPI:1912048125
Name:PENNER, ANNE ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZABETH
Last Name:PENNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 N TYLER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4916
Mailing Address - Country:US
Mailing Address - Phone:316-729-9100
Mailing Address - Fax:316-729-0407
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4916
Practice Address - Country:US
Practice Address - Phone:316-729-9100
Practice Address - Fax:316-729-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSQ11726Medicare UPIN