Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4301102671 | MI |
Y | 207P00000X | Emergency Physician | 73109 | WI |
N | 207P00000X | Emergency Physician | MD0000057098 | TN |
NPI | 1013259613 |
---|---|
Provider Name | Mckenna Jean Knych |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013259613 | (05) | WI |