Individual
MS. JUDITH MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 295-5387
(810) 794-4124
Mailing address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 295-5387
(810) 794-4124
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704145383
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4605447
—
MI
Enumeration date
11/04/2005
Last updated
05/27/2009
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