Provider Demographics
NPI:1083947808
Name:MACDONALD-FENNESSY, MARTHA (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MACDONALD-FENNESSY
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 5TH AVE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1009
Mailing Address - Country:US
Mailing Address - Phone:212-942-8650
Mailing Address - Fax:
Practice Address - Street 1:103 5TH AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1009
Practice Address - Country:US
Practice Address - Phone:212-942-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350686363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health