Individual
JULIE D KENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-6107
Mailing address
5901 LINCOLN DR CBC-2-REV/PE, EDINA, MN 55436-1611
(952) 992-5691
(952) 992-6917
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R118106-7
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
767017600
—
MN
Enumeration date
07/20/2005
Last updated
04/27/2018
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