Provider Demographics
NPI:1821301458
Name:KERNAN, MARY E (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:KERNAN
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:PRIMARY CARE CENTER, YALE NEW HAVEN HOSPITAL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2471
Mailing Address - Fax:203-688-4092
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:PRIMARY CARE CENTER, YALE NEW HAVEN HOSPITAL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2471
Practice Address - Fax:203-688-4092
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CTR41562163W00000X
CT004218363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse