Provider Demographics
NPI:1891509741
Name:MCKENNA, JENNETTE RENE'
Entity type:Individual
Prefix:
First Name:JENNETTE
Middle Name:RENE'
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:R
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN
Mailing Address - Street 1:2501 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1305
Mailing Address - Country:US
Mailing Address - Phone:605-336-3230
Mailing Address - Fax:612-725-1287
Practice Address - Street 1:2501 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1305
Practice Address - Country:US
Practice Address - Phone:605-336-3230
Practice Address - Fax:612-725-1287
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD030435163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care