Healthcare Provider Details

I. General information

NPI: 1952951691
Provider Name (Legal Business Name): MARY EILEEN KIERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 09/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4607
US

IV. Provider business mailing address

83 GRAND BLVD
SCARSDALE NY
10583-5220
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 347-468-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345029
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: