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Individual

ANNA JOYCE KENNEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
2505 OAK RD, PLYMOUTH, IN 46563-9757
(800) 635-5516
Mailing address
328 N MICHIGAN ST, SUITE 200, SOUTH BEND, IN 46601-1244
(574) 647-1069
(574) 647-1825

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71001010A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
71001010A
NP LICENSE
IN
Enumeration date
03/14/2006
Last updated
07/08/2007
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