Provider Demographics
NPI:1902952260
Name:KENNEDY, MARGARET MARY (CNM)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27185 RAINBOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4514
Mailing Address - Country:US
Mailing Address - Phone:818-216-2617
Mailing Address - Fax:
Practice Address - Street 1:123 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2049
Practice Address - Country:US
Practice Address - Phone:760-645-3447
Practice Address - Fax:951-200-4396
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA262592163W00000X
CA7130363LW0102X
CA1006367A00000X
CANM 1006367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health