Individual
KELLEY ELIZABETH VISWANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
85 HIGH ST, MEDFORD, MA 02155
(781) 396-4770
Mailing address
77 POND AVE APARTMENT 1109, BROOKLINE, MA 02445
(651) 278-2390
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP9389209
FL
Other
Enumeration date
11/09/2015
Last updated
11/17/2017
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