Provider Demographics
NPI:1447673058
Name:KENNEDY, ANN MARIE (STUDENT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WHITMAN ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4428
Mailing Address - Country:US
Mailing Address - Phone:321-279-2873
Mailing Address - Fax:617-516-0281
Practice Address - Street 1:33 WHITMAN ST
Practice Address - Street 2:1R
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-4428
Practice Address - Country:US
Practice Address - Phone:312-279-2873
Practice Address - Fax:617-516-0281
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program