Provider Demographics
NPI:1720815970
Name:KENNERLY, ALICE DA PALMA
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:DA PALMA
Last Name:KENNERLY
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 1:10153 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-1017
Mailing Address - Country:US
Mailing Address - Phone:503-310-5694
Mailing Address - Fax:
Practice Address - Street 1:10153 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97231-1017
Practice Address - Country:US
Practice Address - Phone:503-310-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR112218374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula