Provider Demographics
NPI:1538313663
Name:KENNEDY, CORI D'ANNE (NMD)
Entity Type:Individual
Prefix:DR
First Name:CORI
Middle Name:D'ANNE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 S RIO DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3381
Mailing Address - Country:US
Mailing Address - Phone:480-219-5042
Mailing Address - Fax:
Practice Address - Street 1:3160 S GILBERT RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5103
Practice Address - Country:US
Practice Address - Phone:480-636-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08-1080175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath