Individual
KATHLEEN MARIE FENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., N.P,
Contact information
Practice address
896 E FOOTHILL BLVD, SAN LUIS OBISPO, CA 93405-1761
(805) 542-0900
Mailing address
896 E FOOTHILL BLVD, SAN LUIS OBISPO, CA 93405-1761
(805) 542-0900
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
7319
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
456414
RN LICENSE #
CA
01
—
7319
NP LICENSE #
CA
Enumeration date
08/18/2005
Last updated
08/06/2009
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