Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 30851 | MN |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 69669 | MN |
NPI | 1356979140 |
---|---|
Provider Name | Kelly Staricha |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2020 |
Last Update Date | 30/08/2021 |