Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP10111 | AZ |
NPI | 1013444066 |
---|---|
Provider Name | Kelly Wesselhoff |
First Address | Phoenix, AZ 85013-4220 |
Second Address | Phoenix, AZ 85013-4294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2017 |
Last Update Date | 26/11/2019 |