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NPI Code Detail

MEDICARE: MRS. KELLENA NICHOLE BARTZ REGISTERED NURSE

MEDICARE:  MRS. KELLENA NICHOLE BARTZ  REGISTERED NURSE
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
1163W00000XRegistered Nurse4704250854MI

General Provider Information

NPI Number : 1417160375
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLENA NICHOLE BARTZ REGISTERED NURSE
Provider Business Mailing Address
First Line : CMR 416 BOX1465
Second Line :
City : APO
State : AE
Zip : 09140
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : CMR 416 BOX C
Second Line :
City : APO
State : AE
Zip : 09140
Country : US
Telephone Number : 098418374512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 04/20/2008

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Directions to “ MRS. KELLENA NICHOLE BARTZ REGISTERED NURSE” Practice Location

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