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NPI Code Detail

MEDICARE: MRS. KELLY LANE CHELUCCI RN

MEDICARE: MRS. KELLY LANE CHELUCCI RN
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
1163WP0808XPsychiatric/Mental Health Registered Nurse201391448RNOR
2163WP0808XPsychiatric/Mental Health Registered NurseRN60350088WA

General Provider Information

NPI Number : 1437505658
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY LANE CHELUCCI RN
Provider Business Mailing Address
First Line : 55 NE GRAND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2968
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 NE GRAND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2968
Country : US
Telephone Number : 503-232-1099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2016
Last Update Date : 05/06/2016

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Directions to “ MRS. KELLY LANE CHELUCCI RN” Practice Location

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