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General NPI Number Information
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NPI Number | 1053079707
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Entity Type | Individual
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Provider Name | ANGELENE ROSE KENNEDY RN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 24230 KARIM BLVD STE 100
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City | NOVI
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State | MI
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Zip | 48375-2960
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Country | US
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Telephone | 248-745-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 28428 W 8 MILE RD UNIT C8
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-5951
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Country | US
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Telephone | 734-560-6538
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 4704309210
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License Number State | MI
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