Individual
KELLY ROBERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2196 WHITE BEAR AVE N, MAPLEWOOD, MN 55109-2708
(651) 704-0322
Mailing address
2196 WHITE BEAR AVE N, SAINT PAUL, MN 55109-2708
(651) 704-0322
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
7676
MN
363LF0000X
Family Nurse Practitioner
Primary
7676
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7676
CNP
MN
Enumeration date
11/03/2020
Last updated
05/18/2021
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