Individual
KELLEY QUALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
21 GRAND ST, SOUTH PORTLAND, ME 04106-2217
(781) 893-6014
Mailing address
21 GRAND ST, SOUTH PORTLAND, ME 04106-2217
(781) 893-6014
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
309069
NY
Other
Enumeration date
04/13/2022
Last updated
04/13/2022
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