Individual
TREKA B WENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
46 E 15TH ST, EDMOND, OK 73013-4301
(405) 844-5210
Mailing address
46 E 15TH ST, EDMOND, OK 73013-4301
(405) 844-5210
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1494
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200072440A
—
OK
Enumeration date
11/17/2006
Last updated
02/12/2008
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