Individual
KEILLAN LEIGH MENNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4915 25TH AVE NE STE 300W, SEATTLE, WA 98105-5668
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60793473
WA
363LF0000X
Family Nurse Practitioner
Primary
AP60793473
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255840559
—
WA
Enumeration date
09/29/2017
Last updated
10/03/2022
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