Doctor Name: | MRS. SUSAN WILKE KEARNEY |
NPI Number: | 1104891266 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | C.P.N.P. |
License Number: | 160006 |
Business Practice Address: | 294 N Main St Suite 101 East Longmeadow, MA - 010281838 |
Business Phone Number: | 4135251870 |
Business Fax Number: | 4135253883 |
Mailing Address: | 294 N Main St, Suite 101 EAST LONGMEADOW |
State: | MA |
Postal Code: | 010281838 |
Phone Number: | 4135251870 |
Fax Number: | 4135253883 |
NPI Enumeration Date: | 02/22/2006 |
NPI Last Update Date: | 03/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 160006 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |