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General NPI Number Information
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NPI Number | 1174830152
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Entity Type | Individual
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Provider Name | KELLY NICOLE TESSER RN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2010
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 115 MICHAELS CT APT 7
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City | MUKWONAGO
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State | WI
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Zip | 53149-1175
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Country | US
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Telephone | 920-410-6719
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Fax |
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Provider Business Mailing Address
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Address Line | 333 SMITH AVE N
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City | SAINT PAUL
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State | MN
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Zip | 55102-2344
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Country | US
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Telephone | 190-410-6719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 120305
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License Number State | MN
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