Healthcare Provider Details

I. General information

NPI: 1376549725
Provider Name (Legal Business Name): MAURA A. KENNEY- KIERAN A.N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 OLD NORTHERN BLVD
ROSLYN NY
11576-2252
US

IV. Provider business mailing address

1405 OLD NORTHERN BLVD
ROSLYN NY
11576-2252
US

V. Phone/Fax

Practice location:
  • Phone: 516-484-6777
  • Fax: 516-484-0037
Mailing address:
  • Phone: 516-484-6777
  • Fax: 516-484-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3033691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: