MEDICARE: JOANNA KELLIN

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	163WC1500X	Community Health Registered Nurse	R-185092-9	MN

General Provider Information

NPI Number	:	1578992020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA KELLIN

Provider Business Mailing Address
First Line	:	712 MINNESOTA AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3035
Country	:	US
Telephone Number	:	218-847-5628
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 MINNESOTA AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3035
Country	:	US
Telephone Number	:	218-847-5628
Fax Number	:

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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Directions to “ JOANNA KELLIN ” Practice Location

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