Individual
KELLI KLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
139 FAIRBANKS RD, CHURCHVILLE, NY 14428-9782
(585) 293-1800
Mailing address
139 FAIRBANKS RD, CHURCHVILLE, NY 14428-9782
(585) 293-1800
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
22541647
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22541647
—
NY
Enumeration date
01/17/2017
Last updated
01/17/2017
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