Individual
KELLY DUEWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3404 WAKE FOREST RD # ROD, RALEIGH, NC 27609-7340
(919) 862-5480
(919) 862-5483
Mailing address
3404 WAKE FOREST RD, RALEIGH, NC 27609-7340
(919) 862-5480
(919) 862-5483
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01632
NC
363AS0400X
Surgical Physician Assistant
011430
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00388622
MEDICARE RAILROAD
NY
Enumeration date
08/27/2006
Last updated
09/07/2012
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