Individual
LISA-ANN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 HINCHMAN AVE, WAYNE, NJ 07470-2360
(973) 595-6996
(973) 595-6706
Mailing address
150 HINCHMAN AVE, WAYNE, NJ 07470-2360
(973) 595-6996
(973) 595-6706
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
26NN09168300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7671008
—
NJ
Enumeration date
12/18/2014
Last updated
12/18/2014
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