Individual
KELLY L WILTSE NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-8244
Mailing address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-2286
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN533442
PA
Other
Enumeration date
06/08/2006
Last updated
09/22/2015
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