Provider Demographics
NPI:1821184920
Name:MCKENNA, LAURA JANE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5201
Mailing Address - Country:US
Mailing Address - Phone:718-282-0228
Mailing Address - Fax:718-282-0228
Practice Address - Street 1:287 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5201
Practice Address - Country:US
Practice Address - Phone:718-282-0228
Practice Address - Fax:718-282-0228
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000931367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife