Kennebeck, Tisha M
Kennebeck, Tisha M is an individual health care provider with primary practice located at 414 Doctors Ct , Oshkosh WI 54901. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Kennebeck, Tisha M can be contacted via phone (920) 303-8700.Contact Information
Primary practice address
414 Doctors Ct
Oshkosh WI 54901
Phone: (920) 303-8700
Fax: (920) 303-5004
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 1085-023 | Wisconsin |
Profile Details
| NPI number | 1710094248 |
|---|---|
| LBN Legal business name | Kennebeck, Tisha M |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 23rd, 2006 |
| Last updated | Mar 7th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710094248 | NPPES |
| Wisconsin | MEDICAID | 42975400 |
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