Provider Demographics
NPI:1275141848
Name:MCKENNA, LONDON NICOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:LONDON
Middle Name:NICOLE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 WALES ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1331
Mailing Address - Country:US
Mailing Address - Phone:570-780-6821
Mailing Address - Fax:570-970-0511
Practice Address - Street 1:11 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1146
Practice Address - Country:US
Practice Address - Phone:570-970-1030
Practice Address - Fax:570-970-0511
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty