Individual
KELLIE A BACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
3111 GUNDERSEN DR, ONALASKA, WI 54650-8447
(608) 775-8630
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1171
WI
363LF0000X
Family Nurse Practitioner
7082
MN
363LP0200X
Pediatric Nurse Practitioner
1171
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43870600
—
WI
Enumeration date
06/01/2005
Last updated
02/06/2020
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