Healthcare Provider Details

I. General information

NPI: 1003065517
Provider Name (Legal Business Name): LAURA LORRAINE MCKENNA NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE BLDG PC218
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

3959 BROADWAY
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5362
  • Fax:
Mailing address:
  • Phone: 212-305-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF350142-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number26NJ00485000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: