Healthcare Provider Details

I. General information

NPI: 1902952260
Provider Name (Legal Business Name): MARGARET MARY KENNEDY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E ALVARADO ST
FALLBROOK CA
92028-2049
US

IV. Provider business mailing address

27185 RAINBOW CREEK DR
TEMECULA CA
92591-4514
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-3447
  • Fax: 951-200-4396
Mailing address:
  • Phone: 818-216-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number7130
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1006
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM 1006
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number262592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: