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General NPI Number Information
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NPI Number | 1669581161
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Entity Type | Individual
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Provider Name | KELLY RAE FLORIANO P.A.
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1711 S STEPHENSON AVE SUITE 225
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3639
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Country | US
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Telephone | 906-776-5860
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Fax | 906-776-5833
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Provider Business Mailing Address
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Address Line | PO BOX 549
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-0549
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Country | US
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Telephone | 906-774-1313
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Fax | 906-776-5639
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601003478
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License Number State | MI
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