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Individual
KELLY J WASKO
Active
Individual
KELLY J WASKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CP000463
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-23603
MEDICA SELECTCARE
—
01
—
182837
UCARE
—
01
—
4994141
SD BCBS
SD
01
—
60832
HEALTH PARTNER
—
05
—
6828360
—
SD
01
—
931451047306
PREFERRED ONE
—
05
—
975839900
—
MN
Enumeration date
04/06/2006
Last updated
08/15/2012
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