Individual
KELLY COLEGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7821 TERRY DR, LA VISTA, NE 68128-3943
(402) 898-0463
Mailing address
420 S WASHINGTON ST, PAPILLION, NE 68046-2667
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
NE
Other
Enumeration date
10/10/2022
Last updated
10/10/2022
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