Healthcare Provider Details

I. General information

NPI: 1568954626
Provider Name (Legal Business Name): KELSEY KATHLEEN HANLON MSN, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY KATHLEEN YASAK

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

319 VINE ST APT 104
PHILADELPHIA PA
19106-1126
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00806600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00064700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: