# KATHLEEN MARIE FENNELLY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1649262429
- **Gender:** F
- **Credential:** R.N., N.P,

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | 7319 | CA | Yes |

## Other

- **Enumeration date:** 08/18/2005
- **Last updated:** 08/06/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 456414 | RN LICENSE \# | CA |
| 01 | — | 7319 | NP LICENSE \# | CA |