Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6000 | NV |
N | 111NI0900X | Internist | 6000 | NV |
Y | 207RH0002X | Hospice and Palliative Medicine | 6000 | NV |
NPI | 1245216662 |
---|---|
Provider Name | Dr. Kelle L Brogan |
First Address | Reno, NV 89502-2055 |
Second Address | Reno, NV 89502-1576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2005 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G36636 | (02) |