Individual
KELLY E ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4600 W LOOMIS RD STE 201, GREENFIELD, WI 53220-4858
(414) 281-4466
Mailing address
3301 W FOREST HOME AVE, MILWAUKEE, WI 53215-2843
(414) 389-2377
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3860
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059814
—
WI
Enumeration date
08/23/2016
Last updated
04/14/2022
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