Individual
KELLY M LOGLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107
(779) 696-9201
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-008105
IL
363LF0000X
Family Nurse Practitioner
209008105
IL
Other
Enumeration date
04/06/2010
Last updated
02/19/2021
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