Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | APRN.CNP.024319 | OH |
NPI | 1073070421 |
---|---|
Provider Name | Kelly K Debrosse |
First Address | Sidney, OH 45365-2401 |
Second Address | Sidney, OH 45365-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 15/12/2020 |