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General NPI Number Information
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NPI Number | 1366030272
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Entity Type | Individual
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Provider Name | COLLEEN ANN MCKENNA RN
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 186 HOSPITAL DR
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City | GRANTSVILLE
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State | WV
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Zip | 26147-7100
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Country | US
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Telephone | 304-354-9244
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Fax |
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Provider Business Mailing Address
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Address Line | 7760 ELIZABETH PIKE
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City | ELIZABETH
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State | WV
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Zip | 26143-7263
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Country | US
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Telephone | 304-482-2470
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 412258
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 64784
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License Number State | WV
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