Provider Demographics
NPI:1477443265
Name:HOULIHAN, MCKHENNA MALAINA
Entity type:Individual
Prefix:
First Name:MCKHENNA
Middle Name:MALAINA
Last Name:HOULIHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKHENNA
Other - Middle Name:MALAINA
Other - Last Name:MATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9750
Mailing Address - Country:US
Mailing Address - Phone:607-857-9315
Mailing Address - Fax:
Practice Address - Street 1:326 WENDE HALL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8013
Practice Address - Country:US
Practice Address - Phone:716-829-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753779163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse