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NPI Code Detail

MEDICARE: MS. EVELEINE LOUISE KENNEDY RN

MEDICARE: MS. EVELEINE LOUISE 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
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse238432-1NY

General Provider Information

NPI Number : 1962727289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EVELEINE LOUISE KENNEDY RN
Provider Business Mailing Address
First Line : 31 INDUSTRIAL BLVD
Second Line :
City : MEDFORD
State : NY
Zip : 11763-2220
Country : US
Telephone Number : 631-924-4411
Fax Number : 631-924-0563
Provider Business Practice Location Address
First Line : 31 INDUSTRIAL BLVD
Second Line :
City : MEDFORD
State : NY
Zip : 11763-2220
Country : US
Telephone Number : 631-924-4411
Fax Number : 631-924-0563
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2010
Last Update Date : 03/30/2010

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