Individual
MARK E KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 STATE ST, LAWRENCEVILLE, IL 62439-1852
(618) 943-1000
Mailing address
2200 STATE ST, LAWRENCEVILLE, IL 62439-1852
(618) 943-1000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038221
CERTIFICATION
IL
Enumeration date
06/14/2007
Last updated
07/08/2007
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