Basic Information
| Provider Information | |||||||||
| NPI: | 1023417755 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEIDI WENNEMER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 905 | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025410905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085488989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 POND ST | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021845351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813482500 | ||||||||
| FaxNumber: | 7818432405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2014 | ||||||||
| LastUpdateDate: | 08/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | WENNEMER | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | KRISTEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5085488989 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 219658 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.