Provider Demographics
NPI:1295891133
Name:MCKENNA, DONNA F (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:F
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW YORK MEDICAL COLLEGE
Mailing Address - Street 2:MUNGER PAVILION SUITE 245
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-8865
Mailing Address - Fax:914-493-7289
Practice Address - Street 1:NEW YORK MEDICAL COLLEGE
Practice Address - Street 2:MUNGER PAVILION SUITE 245
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8865
Practice Address - Fax:914-493-7289
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02567540Medicaid