Individual
KELLEY E FARNSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
960 N 12TH ST, SUITE 1800, MILWAUKEE, WI 53233-1306
(414) 278-9000
(414) 278-9005
Mailing address
960 N 12TH ST, SUITE 1800, MILWAUKEE, WI 53233-1306
(414) 278-9000
(414) 278-9005
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1051-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42982600
—
WI
Enumeration date
06/04/2006
Last updated
10/24/2007
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