Healthcare Provider Details

I. General information

NPI: 1306024500
Provider Name (Legal Business Name): RACHEL KENNEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10029 CLEVELAND AVE. SE
MAGNOLIA OH
44643
US

IV. Provider business mailing address

10029 CLEVELAND AVE. SE
MAGNOLIA OH
44643
US

V. Phone/Fax

Practice location:
  • Phone: 330-234-3860
  • Fax: 234-386-0108
Mailing address:
  • Phone: 330-234-3860
  • Fax: 330-244-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18187-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: