Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 9173T | CA |
NPI | 1013055292 |
---|---|
Provider Name | Dr. Kelly Ann Mcgrane |
First Address | Roseville, CA 95747-8917 |
Second Address | Roseville, CA 95678-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 30/12/2021 |