NPI | 1518129220 |
---|---|
Former Name | MARY ELIZABETH KENNEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01614) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012488) |
207Q00000X Family Medicine (Licence: MD H72623) | |
Enumeration Date | 2008-06-25 |
Last Update Date | 2020-04-28 |