Provider Demographics
NPI:1093869406
Name:MCKENNEY, MAUREEN SUZANNE (OMD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:SUZANNE
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 LAKESIDE DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8504
Mailing Address - Country:US
Mailing Address - Phone:775-825-1912
Mailing Address - Fax:775-322-1010
Practice Address - Street 1:6135 LAKESIDE DR
Practice Address - Street 2:SUITE 119
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8504
Practice Address - Country:US
Practice Address - Phone:775-825-1912
Practice Address - Fax:775-322-1010
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist