Individual
MRS. RENEE KENWORTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
MACH/RPC, MARTIN LOOP BLDG 9224, FORT BENNING, GA 31905
(706) 544-3919
(706) 544-2790
Mailing address
5 WHITE PINE WAY, PHENIX CITY, AL 36869-7983
(334) 214-5332
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LP00053625
WA
164W00000X
Licensed Practical Nurse
Primary
LPN072185
GA
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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