Healthcare Provider Details

I. General information

NPI: 1477973733
Provider Name (Legal Business Name): KELLI F DALY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2131
US

IV. Provider business mailing address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2131
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-2900
  • Fax: 952-928-2944
Mailing address:
  • Phone: 952-928-2900
  • Fax: 952-928-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR 177398-3
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR 177398-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: