Individual
JENNA FENWCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15480 ANNAPOLIS RD, BOWIE, MD 20715-1852
(240) 893-9728
Mailing address
13204 VANESSA AVE, BOWIE, MD 20720-4748
(240) 893-9728
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
451026
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
451026
PROSTHETIC SPECIALIST
MD
Enumeration date
11/03/2019
Last updated
11/03/2019
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