Individual
DANA LYNNE KELLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1411 EAST 31ST ST, OAKLAND, CA 94602-1018
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTH STAR WAY, MODESTO, CA 95356
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
364SE0003X
Emergency Clinical Nurse Specialist
Primary
PA13877
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0PA138770
—
CA
Enumeration date
11/16/2005
Last updated
07/08/2007
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