Healthcare Provider Details

I. General information

NPI: 1356129126
Provider Name (Legal Business Name): ANABEL ELIZABETH KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PKWY CDW6
PORTLAND OR
97239
US

IV. Provider business mailing address

3181 SW SAM JACKSON PKWY CDW6
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number201802291RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: