| Doctor Name: | MRS. LAURIE ANN MCKENNA |
| NPI Number: | 1013209543 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 40-401097 |
| Business Practice Address: | 104 Main St Queensbury, NY - 128044055 |
| Business Phone Number: | 5182230812 |
| Business Fax Number: | |
| Mailing Address: | 104 Main St, QUEENSBURY |
| State: | NY |
| Postal Code: | 128044055 |
| Phone Number: | 5182230812 |
| Fax Number: | |
| NPI Enumeration Date: | 05/02/2011 |
| NPI Last Update Date: | 07/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 40-401097 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |