Individual
DIANE M KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
7902 NE ST JOHNS RD, VANCOUVER, WA 98665-1094
(360) 573-6424
Mailing address
9105 NE 25TH AVE, VANCOUVER, WA 98665-9057
(360) 573-8183
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA0005268
WA
Other
Enumeration date
05/03/2006
Last updated
07/08/2007
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