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Individual

KELSEY S IVUSICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AGACNP-BC

Contact information

Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1590
(410) 328-8141
(410) 328-0177
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-8040
(443) 462-3514

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R186021
MD

Other

Enumeration date
06/27/2019
Last updated
08/26/2019
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