Individual
MS. ANTOINETTE LASHAWN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 WANDA ST, ROCHESTER, NY 14621-2417
(585) 298-8122
Mailing address
25 WANDA ST, ROCHESTER, NY 14621-2417
(585) 298-8122
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10289950
NY
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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