Individual
KELSEY PAIGE PENDLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 N 108TH PL STE 100, WAUWATOSA, WI 53226-4253
(414) 797-3551
Mailing address
530 N 108TH PL STE 100, WAUWATOSA, WI 53226-4253
(414) 797-3551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
51558
KY
207Q00000X
Family Medicine Physician
Primary
71109-20
WI
207Q00000X
Family Medicine Physician
MT209128
PA
Other
Enumeration date
04/06/2015
Last updated
11/24/2021
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