Individual
MRS. TINA MARIE MCKENNON
Active
Individual
MRS. TINA MARIE MCKENNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
26NJ01153900
NJ
363LA2200X
Adult Health Nurse Practitioner
A0915003
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP015746
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103155510
—
PA
Enumeration date
01/28/2016
Last updated
06/29/2022
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