Provider Demographics
NPI:1952508731
Name:KAVANAGH, YANNY Y (RN,C,MSN,ANCC)
Entity Type:Individual
Prefix:MS
First Name:YANNY
Middle Name:Y
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:RN,C,MSN,ANCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHA - ELDER SERVICE PLAN
Mailing Address - Street 2:163 GORE STREET
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1119
Mailing Address - Country:US
Mailing Address - Phone:617-575-5850
Mailing Address - Fax:617-575-5860
Practice Address - Street 1:1493 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1047
Practice Address - Country:US
Practice Address - Phone:617-665-1552
Practice Address - Fax:617-665-1925
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse