Individual
KELLY DAWN BLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-6420
Mailing address
2100 POWELL ST, STE 900, EMERYVILLE, CA 94608-1844
(510) 851-7423
(510) 879-9120
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003451
IL
Other
Enumeration date
12/16/2008
Last updated
03/15/2017
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