Individual
LISA ANN KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
16931 BAYOU LN, FONTANA, CA 92336-2199
(909) 921-3072
Mailing address
16931 BAYOU LN, FONTANA, CA 92336-2199
(909) 921-3072
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
95009012
CA
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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