Healthcare Provider Details

I. General information

NPI: 1023324894
Provider Name (Legal Business Name): MAUREEN MCKENNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MAIN ST
SPRINGFIELD MA
01107-1089
US

IV. Provider business mailing address

1 ALDRICH ST
NORTHAMPTON MA
01060-2214
US

V. Phone/Fax

Practice location:
  • Phone: 800-258-4448
  • Fax: 413-739-5812
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number202676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: