Individual
KELLIE KERSHISNIK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7455 VILLAGE DR, LINO LAKES, MN 55014-1181
(651) 717-3400
Mailing address
11111 IRONWOOD AVE N, STILLWATER, MN 55082-5068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38004
MN
Other
Enumeration date
05/15/2006
Last updated
07/08/2007
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