Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD182299 | OR |
NPI | 1003250176 |
---|---|
Provider Name | Kathleen Mckenna |
First Address | Hood River, OR 97031-1956 |
Second Address | Hood River, OR 97031-1956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 28/01/2019 |