Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APRN02147 | RI |
NPI | 1003466335 |
---|---|
Provider Name | Susan Patricia Mckenna |
First Address | Johnston, RI 02919-3278 |
Second Address | Johnston, RI 02919-3278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |