Provider Demographics
NPI:1770639304
Name:KENNEDY, MARTHA MERRITT (PHD RN CCRN ACNP)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MERRITT
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:PHD RN CCRN ACNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:315 WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4425
Mailing Address - Country:US
Mailing Address - Phone:410-323-9631
Mailing Address - Fax:
Practice Address - Street 1:JOHNS HOPKINS DEPARTMENT OF SURGERY
Practice Address - Street 2:600 NORTH WOLFE, HALSTED 600
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-502-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR086277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care