Individual
KELLY THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP, FNP
Contact information
Practice address
930 E KNAPP ST, STE 34, MILWAUKEE, WI 53202
(414) 671-9355
(888) 376-4067
Mailing address
345 W RAVINE BAYE RD, BAYSIDE, WI 53217-1336
(262) 308-7989
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
6467-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
6467
WI
Other
Enumeration date
07/15/2015
Last updated
02/13/2022
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