MEDICARE: DANA KELLY RN,C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP1700X	Perinatal Registered Nurse	1806436	MN

General Provider Information

NPI Number	:	1245169242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA KELLY RN,C

Provider Business Mailing Address
First Line	:	5379 BROOKS CIR SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5379 BROOKS CIR SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2559
Country	:	US
Telephone Number	:	612-214-5217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2026
Last Update Date	:	05/15/2026

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