Individual
MS. MARY M KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., N.P., C.N.M.
Contact information
Practice address
7601 STONERIDGE DR, THE PERMANENTE MEDICAL GROUP, PLEASANTON, CA 94588-4501
(925) 847-5629
(925) 847-5148
Mailing address
7601 STONERIDGE DR, THE PERMANENTE MEDICAL GROUP, PLEASANTON, CA 94588-4501
(925) 847-5629
(925) 847-5148
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
177602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
177602
RN LICENSE NUMBER
CA
Enumeration date
09/08/2005
Last updated
07/08/2007
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