Individual
MS. DIANE KENEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN NNP
Contact information
Practice address
5501 OLD YORK RD # PALEY1, PHILADELPHIA, PA 19141-3018
(215) 456-7170
(215) 456-4923
Mailing address
101 E OLNEY AVE STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-1825
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
26NN09780100
NJ
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
SP012130
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1038803330002
—
PA
Enumeration date
11/02/2006
Last updated
08/10/2022
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