Provider Demographics
NPI:1659624377
Name:MCKENNA, MARIA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNN
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-2434
Mailing Address - Country:US
Mailing Address - Phone:814-873-4275
Mailing Address - Fax:
Practice Address - Street 1:521 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-2434
Practice Address - Country:US
Practice Address - Phone:814-873-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN282139164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse