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General NPI Number Information
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NPI Number | 1023324894
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Entity Type | Individual
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Provider Name | MAUREEN MCKENNA NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 3550 MAIN ST
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City | SPRINGFIELD
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State | MA
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Zip | 01107-1089
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Country | US
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Telephone | 800-258-4448
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Fax | 413-739-5812
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Provider Business Mailing Address
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Address Line | 1 ALDRICH ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 202676
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License Number State | MA
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