MEDICARE: MR. DANIEL O'NEILL KENNEDY RN

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
1	163WM0705X	Medical-Surgical Registered Nurse	560769	TX

General Provider Information

NPI Number	:	1447326590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL O'NEILL KENNEDY RN

Provider Business Mailing Address
First Line	:	10408 FARMVIEW CT
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6909
Country	:	US
Telephone Number	:	301-619-4062
Fax Number	:	301-619-4480

Provider Business Practice Location Address
First Line	:	1432 SULTAN DRIVE, SUITE 100
Second Line	:
City	:	FORT DETRICK
State	:	MD
Zip	:	21702-5001
Country	:	US
Telephone Number	:	301-619-4062
Fax Number	:	301-619-4480

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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