Healthcare Provider Details

I. General information

NPI: 1508036351
Provider Name (Legal Business Name): DANA KELLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE 7TH FLOOR
EVERETT WA
98201-4147
US

IV. Provider business mailing address

916 PACIFIC AVE 7TH FLOOR
EVERETT WA
98201-4147
US

V. Phone/Fax

Practice location:
  • Phone: 425-303-6500
  • Fax: 425-303-6550
Mailing address:
  • Phone: 425-303-6500
  • Fax: 425-303-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00056035
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00056035
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00056035
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN00056035
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN00056035
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00056035
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00056035
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberRN00056035
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN00056035
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: