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NPI Code Detail

MEDICARE: MS. JUDITH MCKENNA RN, NP

MEDICARE: MS. JUDITH MCKENNA RN, NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704145383MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255322467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH MCKENNA RN, NP
Provider Business Mailing Address
First Line : 15855 19 MILE RD
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-3504
Country : US
Telephone Number : 586-295-5387
Fax Number : 810-794-4124
Provider Business Practice Location Address
First Line : 15855 19 MILE RD
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-3504
Country : US
Telephone Number : 586-295-5387
Fax Number : 810-794-4124
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 05/27/2009

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