Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 2362924 | MN |
N | 363LN0000X | Nurse Practitioner - Neonatal | 209.010210 | IL |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 5884 | WI |
NPI | 1093054074 |
---|---|
Provider Name | Kelley Ann Zhovtis |
First Address | La Crosse, WI 54601-5429 |
Second Address | Rochester, MN 55905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2013 |
Last Update Date | 22/01/2021 |