Provider Demographics
NPI:1538676333
Name:KENNEDY, MAREN K (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:K
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT STREET / HEARTLAND CARE PARTNERS
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:800-427-1902
Mailing Address - Fax:419-531-2664
Practice Address - Street 1:1480 OXFORD VALLEY ROAD / HEARTLAND CARE PARTNERS
Practice Address - Street 2:
Practice Address - City:YARDELY
Practice Address - State:PA
Practice Address - Zip Code:19067-5630
Practice Address - Country:US
Practice Address - Phone:800-427-1902
Practice Address - Fax:419-531-2664
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner