Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 202676 | MA |
NPI | 1023324894 |
---|---|
Provider Name | Maureen Mckenna |
First Address | Northampton, MA 01060-2214 |
Second Address | Springfield, MA 01107-1089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 10/04/2018 |