Provider Demographics
NPI:1447215272
Name:MCDONNELL, KATHLEEN MARIE (PNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1465
Mailing Address - Country:US
Mailing Address - Phone:716-706-2034
Mailing Address - Fax:716-705-2035
Practice Address - Street 1:2875 UNION RD
Practice Address - Street 2:SUITE 21
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1465
Practice Address - Country:US
Practice Address - Phone:716-706-2034
Practice Address - Fax:716-705-2035
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY380258363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01470075Medicaid
NY9512021OtherINDEPENDENT HEALTH
NY000560343007OtherBLUE CROSS/BLUE SHIELD OF WNY
NY040426001221OtherFIFELIS CARE NY