Individual
DR. SUSAN DANA KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REV
Contact information
Practice address
2 WILD IRIS WAY, GREENSBORO, NC 27410-4169
(336) 456-7777
Mailing address
2 WILD IRIS WAY, GREENSBORO, NC 27410-4169
(336) 323-6688
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
USA.07.2000.H
NY
Other
Enumeration date
09/16/2011
Last updated
09/16/2011
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