Individual
MARIE ANTOINETTE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
611 E DOUGLAS RD STE 208, MISHAWAKA, IN 46545-1465
(574) 335-6000
(574) 335-0738
Mailing address
707 CEDAR ST STE 200, SOUTH BEND, IN 46617-2057
(574) 335-8707
(574) 335-0741
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71007869A
IN
363LG0600X
Gerontology Nurse Practitioner
28143781A
IN
363LG0600X
Gerontology Nurse Practitioner
71007869A
IN
Other
Enumeration date
02/01/2018
Last updated
06/19/2024
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