Individual
KELLI LOUISE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10412 264TH ST E, GRAHAM, WA 98338-8795
(253) 800-8693
Mailing address
516 176TH ST E, SPANAWAY, WA 98387-8335
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN60594938
WA
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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