Provider Demographics
NPI:1497051817
Name:KEARNEY, ANN L (RN BSN IBCLC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DYER AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3234
Mailing Address - Country:US
Mailing Address - Phone:860-841-4985
Mailing Address - Fax:
Practice Address - Street 1:76 DYER AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3234
Practice Address - Country:US
Practice Address - Phone:860-841-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE57025163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant