Individual
MS. KELLY JEAN MIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5454 HOHMAN AVE, HAMMOND, IN 46320-1931
(219) 932-2300
Mailing address
1726 SHERIDAN AVE, WHITING, IN 46394-1729
(219) 218-6730
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28151162A
IN
Other
Enumeration date
11/19/2012
Last updated
08/14/2015
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