Individual
MRS. KELLY LANE CHELUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
55 NE GRAND AVE, PORTLAND, OR 97232-2968
(503) 232-1099
Mailing address
55 NE GRAND AVE, PORTLAND, OR 97232-2968
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201391448RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN60350088
WA
Other
Enumeration date
05/06/2016
Last updated
05/06/2016
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