Healthcare Provider Details

I. General information

NPI: 1275707861
Provider Name (Legal Business Name): MARIA GABRIELA KENNEDY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827
NAPLES CAMPANIA
FPO AE
IT

IV. Provider business mailing address

PSC 827
NAPLES CAMPANIA
FPO AE
IT

V. Phone/Fax

Practice location:
  • Phone: 6296150
  • Fax:
Mailing address:
  • Phone: 6296150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number620723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: