Healthcare Provider Details

I. General information

NPI: 1376057497
Provider Name (Legal Business Name): JULIA ROSE KENNY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 5TH AVE
NEW YORK NY
10035-4521
US

IV. Provider business mailing address

1432 5TH AVE
NEW YORK NY
10035-4521
US

V. Phone/Fax

Practice location:
  • Phone: 646-289-7700
  • Fax:
Mailing address:
  • Phone: 646-289-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number678251
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number678251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: