Individual
KELLI JO-ANN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
Mailing address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
28188683A
IN
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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