Provider Demographics
NPI:1811976749
Name:KENNEALEY-MCMANUS, ANNE (NP, RN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KENNEALEY-MCMANUS
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Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1153 CENTRE ST
Mailing Address - Street 2:BWH-FH
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-7179
Mailing Address - Fax:671-983-7825
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:FAULKNER BREAST CENTRE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7773
Practice Address - Fax:617-983-7779
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA100002364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0387100Medicaid
MA0387100Medicaid