Provider Demographics
NPI:1831673474
Name:KENNEDY, MARLENA (ND)
Entity Type:Individual
Prefix:DR
First Name:MARLENA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 19TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5957
Mailing Address - Country:US
Mailing Address - Phone:701-314-9904
Mailing Address - Fax:
Practice Address - Street 1:2860 19TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5957
Practice Address - Country:US
Practice Address - Phone:701-314-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4187175F00000X
ND2022-01175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath