Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1205497369 |
---|---|
Provider Name | Sharon L Kelly |
First Address | Carson City, NV 89706-7815 |
Second Address | Carson City, NV 89706-7815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
474708752 | (05) | NV |