Provider Demographics
NPI:1982896064
Name:KENNEY-LAVIN, ROSEMARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:
Last Name:KENNEY-LAVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4626
Mailing Address - Country:US
Mailing Address - Phone:207-623-2977
Mailing Address - Fax:207-626-9374
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4626
Practice Address - Country:US
Practice Address - Phone:207-623-2977
Practice Address - Fax:207-626-9374
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME035706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME303460099Medicaid
ME303460099Medicaid