Provider Demographics
NPI:1164673109
Name:MC KENNA, URSULA G (MD)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:G
Last Name:MC KENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 MERRIHILLS DR IVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1160
Mailing Address - Country:US
Mailing Address - Phone:507-285-0010
Mailing Address - Fax:
Practice Address - Street 1:2040 MERRIHILLS DR SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1160
Practice Address - Country:US
Practice Address - Phone:507-285-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21460207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN904316100Medicaid
MN930000062Medicare PIN