Healthcare Provider Details

I. General information

NPI: 1811976749
Provider Name (Legal Business Name): ANNE KENNEALEY-MCMANUS NP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 CENTRE ST FAULKNER BREAST CENTRE
BOSTON MA
02130-3446
US

IV. Provider business mailing address

1153 CENTRE ST BWH-FH
JAMAICA PLAIN MA
02130-3446
US

V. Phone/Fax

Practice location:
  • Phone: 617-983-7773
  • Fax: 617-983-7779
Mailing address:
  • Phone: 617-983-7179
  • Fax: 671-983-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number100002
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: