Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP022804 | PA |
NPI | 1023612991 |
---|---|
Provider Name | Mrs. Kelly Lynn Drane |
First Address | Harrisburg, PA 17101-2010 |
Second Address | Harrisburg, PA 17101-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2020 |
Last Update Date | 05/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SPO22804 | CRNP LICENSE (01) | PA |