Individual
MR. KENNETH T WALLENFELSZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
3528 TONGASS AVE, KETCHIKAN, AK 99901-5635
(907) 220-4447
Mailing address
3528 TONGASS AVE, KETCHIKAN, AK 99901-5635
(907) 220-4447
(949) 577-4111
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60207225
WA
363LF0000X
Family Nurse Practitioner
201500491NP-PP
OR
363LF0000X
Family Nurse Practitioner
AP60207225
WA
363LF0000X
Family Nurse Practitioner
Primary
NURU1255
AK
Other
Enumeration date
07/19/2011
Last updated
12/16/2024
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