Provider Demographics
NPI:1154547610
Name:DINNELLA, KERRY LYN (RN)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:LYN
Last Name:DINNELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4716
Mailing Address - Country:US
Mailing Address - Phone:928-279-0109
Mailing Address - Fax:
Practice Address - Street 1:2126 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4716
Practice Address - Country:US
Practice Address - Phone:928-279-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098843163WG0000X, 163WG0600X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Not Answered163WG0600XNursing Service ProvidersRegistered NurseGerontology
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care