Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00756300 | NJ |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 26NJ00756300 | NJ |
NPI | 1124537964 |
---|---|
Provider Name | Kaleena Kenny |
First Address | Old Bridge, NJ 08857-2520 |
Second Address | Old Bridge, NJ 08857-2520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 25/09/2017 |