Individual
NANEKA S KENNON PAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
3469 HENLEY ST, REX, GA 30273-1758
(404) 552-1125
Mailing address
3469 HENLEY ST, REX, GA 30273-1758
(404) 552-1125
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN275536
GA
Other
Enumeration date
01/17/2020
Last updated
01/17/2020
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