Healthcare Provider Details

I. General information

NPI: 1265959944
Provider Name (Legal Business Name): SHEILA MARIE KENNEDY DNP, APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 35TH ST
MINNEAPOLIS MN
55408-4580
US

IV. Provider business mailing address

324 E 35TH ST
MINNEAPOLIS MN
55408-4580
US

V. Phone/Fax

Practice location:
  • Phone: 612-821-2007
  • Fax: 612-767-4545
Mailing address:
  • Phone: 612-821-2007
  • Fax: 612-767-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: