Individual
KELLEY HAERTILNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1141 PCR 917, PERRYVILLE, MO 63775-8347
(573) 846-6153
Mailing address
1141 PCR 917, PERRYVILLE, MO 63775-8347
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/06/2019
Last updated
03/06/2019
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