MEDICARE: MRS. KELLI ELAINE QUICK BEAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1013672757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLI ELAINE QUICK BEAR

Provider Business Mailing Address
First Line	:	PO BOX 625
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763-0625
Country	:	US
Telephone Number	:	701-421-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2860 85TH AVE NW
Second Line	:
City	:	NEW TOWN
State	:	ND
Zip	:	58763-5876
Country	:	US
Telephone Number	:	701-421-1623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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