Provider Demographics
NPI:1548527658
Name:DONNELLY, KENDRA LYNNE
Entity type:Individual
Prefix:MISS
First Name:KENDRA
Middle Name:LYNNE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 OWENS RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NY
Mailing Address - Zip Code:13832
Mailing Address - Country:US
Mailing Address - Phone:607-336-3314
Mailing Address - Fax:
Practice Address - Street 1:164 OWENS ROAD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NY
Practice Address - Zip Code:13832
Practice Address - Country:US
Practice Address - Phone:607-336-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282173-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse