Healthcare Provider Details

I. General information

NPI: 1134449077
Provider Name (Legal Business Name): COLLEEN KENNEDY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 REMINGTON AVE STE 2000
BALTIMORE MD
21211
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR # 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 667-312-2400
  • Fax:
Mailing address:
  • Phone: 410-933-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR175040
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: