Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | R175040 | MD |
NPI | 1134449077 |
---|---|
Provider Name | Colleen Kennedy |
First Address | Baltimore, MD 21236-4902 |
Second Address | Baltimore, MD 21211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 04/06/2018 |