Individual
LISA KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.N.M.
Contact information
Practice address
1775 WILLISTON RD, SUITE 220, SOUTH BURLINGTON, VT 05403-6491
(802) 861-0200
(802) 861-0210
Mailing address
66 BARTLETT BAY RD, SOUTH BURLINGTON, VT 05403-7737
(802) 777-8997
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
101-0014084
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00059280
BCBS
VT
05
—
1009149
—
VT
01
—
361683
MVP
VT
01
—
5207602
VERMONT MANAGED CARE
VT
Enumeration date
12/29/2005
Last updated
08/13/2010
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