Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 74976 | WI |
NPI | 1689800401 |
---|---|
Provider Name | Kelly Lynne Jones |
First Address | Milwaukee, WI 53226-3533 |
Second Address | Milwaukee, WI 53226-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 17/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05788256 | (05) | MS |
1689800401 | (05) | WI |