Healthcare Provider Details

I. General information

NPI: 1700710274
Provider Name (Legal Business Name): KELSEY GREEN RN
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KELSEY WILLIAMS RN

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 E DIVISION ST
RIVER FALLS WI
54022-2599
US

IV. Provider business mailing address

1120 178TH ST
HAMMOND WI
54015-5418
US

V. Phone/Fax

Practice location:
  • Phone: 715-425-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number190013
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: