Provider Demographics
NPI:1982014106
Name:MCKENNA, MARIA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-5142
Mailing Address - Country:US
Mailing Address - Phone:516-382-2216
Mailing Address - Fax:
Practice Address - Street 1:942 ROUTE 376
Practice Address - Street 2:SUITE 16
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6483
Practice Address - Country:US
Practice Address - Phone:845-223-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306553363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health