Provider Demographics
NPI:1629055876
Name:KENISON, MARY ELIZABETH (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:KENISON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:47 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:NH
Mailing Address - Zip Code:03582-4061
Mailing Address - Country:US
Mailing Address - Phone:603-636-1101
Mailing Address - Fax:603-788-5027
Practice Address - Street 1:47 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:NH
Practice Address - Zip Code:03582-4061
Practice Address - Country:US
Practice Address - Phone:603-636-1101
Practice Address - Fax:603-788-5027
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0363542303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006374Medicaid
NH30011451Medicaid
NH30011451Medicaid
NHP21200Medicare UPIN