Individual
MRS. KELLY MARIE MCSHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
301 W HOMER ST, MICHIGAN CITY, IN 46360-4358
(219) 488-7781
Mailing address
10420 BULL RUN DR, SAINT JOHN, IN 46373-9109
(219) 488-7781
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28170048A
IN
Other
Enumeration date
09/15/2010
Last updated
09/24/2012
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