Provider Demographics
NPI:1679354104
Name:ENNEN, KALA RAE ANN
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:RAE ANN
Last Name:ENNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KALA
Other - Middle Name:RAE ANN
Other - Last Name:INGWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1041 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3930
Mailing Address - Country:US
Mailing Address - Phone:608-343-6916
Mailing Address - Fax:
Practice Address - Street 1:1041 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-3930
Practice Address - Country:US
Practice Address - Phone:608-343-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program