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General NPI Number Information
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NPI Number | 1700691961
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Entity Type | Individual
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Provider Name | LISA ANNE KELLEY
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2811 WILSHIRE BLVD STE 610
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City | SANTA MONICA
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State | CA
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Zip | 90403-4814
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Country | US
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Telephone | 310-453-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 PERRY AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90278-1824
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Country | US
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Telephone | 310-415-4148
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95033922
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License Number State | CA
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