Provider Demographics
NPI:1053988352
Name:DUFF, MCKENNA ANN (RN,BSN)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:ANN
Last Name:DUFF
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3971
Mailing Address - Country:US
Mailing Address - Phone:641-954-1375
Mailing Address - Fax:
Practice Address - Street 1:920 S 5TH AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3971
Practice Address - Country:US
Practice Address - Phone:641-954-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA163611163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163611OtherNURSING LICENSE