Individual
HOLLY RAE KELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1414 GROVER ST, SPRINGFIELD, OH 45505-3925
(937) 206-1897
Mailing address
1414 GROVER ST, SPRINGFIELD, OH 45505-3925
(937) 206-1897
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN113181
OH
Other
Enumeration date
03/27/2009
Last updated
03/27/2009
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