| Doctor Name: | MR. JESSE WOISARD WENNIK |
| NPI Number: | 1073651154 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP, CNS |
| License Number: | 16967 |
| Business Practice Address: | 250 Bon Air Rd Greenbrae, CA - 949041702 |
| Business Phone Number: | 4154996835 |
| Business Fax Number: | 4155074113 |
| Mailing Address: | 250 Bon Air Rd, Suite B GREENBRAE |
| State: | CA |
| Postal Code: | 949041702 |
| Phone Number: | 4154732964 |
| Fax Number: | 4154734113 |
| NPI Enumeration Date: | 02/02/2007 |
| NPI Last Update Date: | 11/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 16967 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |