Provider Demographics
NPI:1619906500
Name:MCKENNEY, GWEN G (CMW)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:G
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:CMW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 ATRIUM WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-206-4500
Mailing Address - Fax:856-234-4241
Practice Address - Street 1:70 COHANSEY ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1918
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-451-0029
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJME00032200176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS52373Medicare UPIN