Individual
KELLIE T SHANHOLTZ
Active
Individual
KELLIE T SHANHOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024134809
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
AC002767
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2604151000
—
WV
Enumeration date
02/28/2006
Last updated
07/17/2019
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