Individual
KELLY DEE VANCLEVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18255 ICON CT, LAKEVILLE, MN 55044-2276
(612) 384-9408
Mailing address
18255 ICON CT, LAKEVILLE, MN 55044-2276
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1700477
MN
Other
Enumeration date
12/10/2020
Last updated
12/10/2020
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