Individual
KELLI RENEE WILDER-OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-6026
Mailing address
3082 WHEELER STATION RD, BLOOMFIELD, NY 14469-9215
(585) 746-3335
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
431324
NY
363LA2100X
Acute Care Nurse Practitioner
Primary
F431324
NY
Other
Enumeration date
07/04/2018
Last updated
06/30/2023
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