Individual
MR. PETER JAMES KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
391 BROAD ST, MERIDEN, CT 06450-5844
(203) 238-1555
Mailing address
12 BUTTONWOOD CIR, WALLINGFORD, CT 06492-5613
(203) 294-9833
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
E34306
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
000196
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
430000104
—
CT
Enumeration date
10/16/2006
Last updated
05/19/2008
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