Individual
LANCE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 E 28TH ST, MINNEAPOLIS, MN 55407-3723
(865) 342-8900
Mailing address
425 PINE RIDGE BLVD, SUITE 211, WAUSAU, WI 54401-4123
(715) 845-5505
(715) 848-2884
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
169078-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA 1911
MN
Other
Enumeration date
10/20/2011
Last updated
05/02/2017
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