Provider Demographics
NPI:1679840417
Name:KENEALLY, BARBARA MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:MARIE
Last Name:KENEALLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2302
Mailing Address - Country:US
Mailing Address - Phone:631-427-0311
Mailing Address - Fax:631-623-4934
Practice Address - Street 1:20 ELLEN AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2302
Practice Address - Country:US
Practice Address - Phone:631-427-0311
Practice Address - Fax:631-623-4934
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256547-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse