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General NPI Number Information
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NPI Number | 1376066118
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Entity Type | Individual
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Provider Name | KELLIE FRANZEN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2103 E WASHINGTON ST STE D
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4310
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Country | US
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Telephone | 888-240-1121
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Fax | 888-496-0086
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Provider Business Mailing Address
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Address Line | 2103 E WASHINGTON ST STE D
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4310
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Country | US
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Telephone | 888-240-1121
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Fax | 888-496-0086
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016121
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License Number State | IL
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