Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 133500 | MA |
NPI | 1003971995 |
---|---|
Provider Name | Ann N Kennefick |
First Address | Wellesley, MA 02481-5263 |
Second Address | Wellesley, MA 02481-6219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP3334 | (02) | MA |
NP3334 | BLUE CROSS (01) | MA |