Provider Demographics
NPI:1518501915
Name:BROWN, KENNA RAE (RN)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:RAE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11662 TOWNSHIP ROAD 20
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:OH
Mailing Address - Zip Code:45836-9746
Mailing Address - Country:US
Mailing Address - Phone:419-889-3135
Mailing Address - Fax:
Practice Address - Street 1:11662 TOWNSHIP ROAD 20
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:OH
Practice Address - Zip Code:45836-9746
Practice Address - Country:US
Practice Address - Phone:419-889-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.341434163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse