MEDICARE: MRS. SANDRA KAY KELMAN WHNP-BC-NP

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	363L00000X	Nurse Practitioner	AP2136	AZ

General Provider Information

NPI Number	:	1821151168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY KELMAN WHNP-BC-NP

Provider Business Mailing Address
First Line	:	PO BOX 10097
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85130-0020
Country	:	US
Telephone Number	:	520-836-3446
Fax Number	:	520-836-8807

Provider Business Practice Location Address
First Line	:	655 S DOBSON RD STE 201
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5669
Country	:	US
Telephone Number	:	480-389-1689
Fax Number	:

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	12/13/2017

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