Individual
SUSANNE MARIE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
907 AURORA AVE, GIRARD, PA 16417-1241
(814) 460-1464
Mailing address
907 AURORA AVE, GIRARD, PA 16417-1241
(814) 460-1464
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN284401
PA
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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