Individual
LORI L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
2845 HAMLINE AVE NORTH, ROSEVILLE, MN 55113
(651) 631-6100
(651) 631-6343
Mailing address
2845 HAMLINE AVE NORTH, ROSEVILLE, MN 55113
(651) 631-6100
(651) 631-6343
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R1533479
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474957000
—
MN
Enumeration date
06/28/2006
Last updated
04/25/2012
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