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Individual

MS. ELIZABETH KATHLEEN KELLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN/RCS

Contact information

Practice address
W4764 HIDDEN PINE LN, SHAWANO, WI 54166-1650
(920) 858-2682
(715) 745-2957
Mailing address
W4764 HIDDEN PINE LN, SHAWANO, WI 54166-1650
(920) 858-2682
(715) 745-2957

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27691-031
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
38275700
WI
Enumeration date
10/23/2007
Last updated
10/23/2007
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