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Individual

KELLY KORENE WHITE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
25945 GATEWAY DR, ZIMMERMAN, MN 55398-5300
(763) 856-6900
Mailing address
25945 GATEWAY DR, ZIMMERMAN, MN 55398-5300
(763) 856-6900

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 147784-9
MN
363LF0000X
Family Nurse Practitioner
Primary
CNP 2080
MN

Other

Enumeration date
12/18/2012
Last updated
06/04/2015
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