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Individual

MR. WARREN M FENNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
25 RIDGEWOOD RD, EMERGENCY DEPARTMENT, SPRINGFIELD, VT 05156-3050
(802) 885-2151
Mailing address
25 RIDGEWOOD RD, EMERGENCY DEPARTMENT, SPRINGFIELD, VT 05156-3050

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055-0031215
VT

Other

Enumeration date
06/12/2013
Last updated
08/12/2014
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