Individual
BONNY KENNEALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6847 W CARTER RD, ROME, NY 13440-1331
(315) 533-0848
Mailing address
6847 W CARTER RD, ROME, NY 13440-1331
(315) 533-0848
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
113890-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01705682
—
NY
Enumeration date
02/01/2010
Last updated
07/26/2013
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