Healthcare Provider Details

I. General information

NPI: 1902724412
Provider Name (Legal Business Name): KEALY MARNELL BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E SILVER SPRING DR
WHITEFISH BAY WI
53217-5222
US

IV. Provider business mailing address

3437 N HUMBOLDT BLVD
MILWAUKEE WI
53212-1701
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1100309-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: