Healthcare Provider Details

I. General information

NPI: 1801046933
Provider Name (Legal Business Name): PATRICIA ANNE MCKENNA MSN,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 MARKET ST SUITE 200
PHILADELPHIA PA
19104-3325
US

IV. Provider business mailing address

3440 MARKET ST SUITE 200
PHILADELPHIA PA
19104-3325
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-7431
  • Fax: 215-590-5052
Mailing address:
  • Phone: 215-590-7431
  • Fax: 215-590-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP005551B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: