Individual
KENDALL CLEVENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
510 2ND ST SE, PINE CITY, MN 55063-1706
(320) 629-6721
Mailing address
13709 BISTRAM RD, GRANTSBURG, WI 54840-7237
(715) 463-3816
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9635
MN
Other
Enumeration date
09/08/2009
Last updated
09/08/2009
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