Individual
KELLY LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
630 W 168TH ST, NEW YORK, NY 10032-3725
(617) 871-9873
Mailing address
630 W 168TH ST, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
383210
NY
Other
Enumeration date
06/05/2017
Last updated
12/29/2020
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