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Individual

KELLY MAE LOSINIECKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
211 N EDDY ST., SOUTH BEND, IN 46617-3096
(574) 237-9231
(574) 204-6355
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-2808
(574) 237-9231

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71003885A
IN
363LF0000X
Family Nurse Practitioner
Primary
28176558A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000758607
BCBS BMG NORTH CENTRAL NEUROSURGERY
IN
05
201058080
IN
01
P01203728
RR MEDICARE
IN
Enumeration date
01/17/2012
Last updated
03/07/2018
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