Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 31878 | AZ |
NPI | 1124121694 |
---|---|
Provider Name | Dr. Aileen Marie Kennedy |
First Address | Anthem, AZ 85086-1568 |
Second Address | Prescott, AZ 86313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |