Individual
MRS. LISA M KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
93 BARKER RD, CENTRAL SQUARE, NY 13036-3460
(315) 668-4253
(315) 668-4299
Mailing address
259 PINNACLE RD, WEST MONROE, NY 13167-4167
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
51338-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51338-1
—
NY
Enumeration date
11/09/2012
Last updated
11/09/2012
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