Provider Demographics
NPI:1114102159
Name:MCKENNA NOLAN, MARY FRANCES
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:MCKENNA NOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1439
Mailing Address - Country:US
Mailing Address - Phone:845-674-7836
Mailing Address - Fax:
Practice Address - Street 1:715 NORTH AVE
Practice Address - Street 2:IONA WELLNESS CENTER
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1830
Practice Address - Country:US
Practice Address - Phone:914-633-2548
Practice Address - Fax:914-633-2103
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331969-1261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health