Individual
SALLY KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 N ROOSEVELT DR, SEASIDE, OR 97138-7044
(503) 717-7150
Mailing address
34080 WOOD DUCK AVE, NEHALEM, OR 97131-9760
(503) 812-2293
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
200641631RN
OR
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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