Provider Demographics
NPI:1376826206
Name:KENNEDO, DIANA (LPN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KENNEDO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 E 95TH ST
Mailing Address - Street 2:2R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2541
Mailing Address - Country:US
Mailing Address - Phone:718-781-9510
Mailing Address - Fax:
Practice Address - Street 1:1342 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4616
Practice Address - Country:US
Practice Address - Phone:718-851-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307022164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse