Provider Demographics
NPI:1073054581
Name:MAHONEY, JENNY (RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1170 15TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2589
Mailing Address - Country:US
Mailing Address - Phone:612-379-1063
Mailing Address - Fax:
Practice Address - Street 1:1170 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2589
Practice Address - Country:US
Practice Address - Phone:612-379-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN243939-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse