Provider Demographics
NPI:1760968671
Name:KENNE, ALIDA N/A
Entity Type:Individual
Prefix:
First Name:ALIDA
Middle Name:N/A
Last Name:KENNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6434 W 89TH ST APT 50
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-6095
Mailing Address - Country:US
Mailing Address - Phone:913-406-6714
Mailing Address - Fax:
Practice Address - Street 1:6434 W 89TH ST APT 50
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-6095
Practice Address - Country:US
Practice Address - Phone:913-406-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse