=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205082211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSEMARIE ANN KENNALEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2008
-----------------------------------------------------
Last Update Date | 02/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 S GILBERT RD STE 101
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-677-8282
-----------------------------------------------------
Fax | 480-677-8283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 S MILL AVE STE 280
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-6850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-305-2888
-----------------------------------------------------
Fax | 480-305-2889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 23812
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------