Healthcare Provider Details

I. General information

NPI: 1396378378
Provider Name (Legal Business Name): KELSEY D MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY D SCHLEDEWITZ RN

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E 7TH ST
MINATARE NE
69356-3994
US

IV. Provider business mailing address

1107 E 7TH ST
MINATARE NE
69356-3994
US

V. Phone/Fax

Practice location:
  • Phone: 308-783-1255
  • Fax:
Mailing address:
  • Phone: 303-656-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number68433
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: