Healthcare Provider Details

I. General information

NPI: 1093869406
Provider Name (Legal Business Name): MAUREEN SUZANNE MCKENNEY O.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 LAKESIDE DR SUITE 119
RENO NV
89511-8504
US

IV. Provider business mailing address

6135 LAKESIDE DR SUITE 119
RENO NV
89511-8504
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-1912
  • Fax: 775-322-1010
Mailing address:
  • Phone: 775-825-1912
  • Fax: 775-322-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1013
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: