Individual
KELLY HACKETT DEFRAIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7 RIP VAN LN, BALLSTON SPA, NY 12020-3006
(914) 456-1341
Mailing address
7 RIP VAN LN, BALLSTON SPA, NY 12020-3006
(914) 456-1341
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
566919
NY
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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