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General NPI Number Information
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NPI Number | 1578376273
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Entity Type | Individual
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Provider Name | KELSEY BROLLIAR FNP
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Gender | Female
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 04/26/2025
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Provider Practice Location Address
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Address Line | 10956 DONNER PASS RD FL 2
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City | TRUCKEE
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State | CA
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Zip | 96161-4861
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Country | US
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Telephone | 530-550-6716
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5202
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City | TAHOE CITY
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State | CA
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Zip | 96145-5202
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Country | US
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Telephone | 530-448-4410
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95033692
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License Number State | CA
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