MEDICARE: KELLEY ELIZABETH DRISCOLL 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	363LF0000X	Family Nurse Practitioner	345118	NY

General Provider Information

NPI Number	:	1881232387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY ELIZABETH DRISCOLL NP

Provider Business Mailing Address
First Line	:	2920 TELEGRAPH AVE STE 100
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2031
Country	:	US
Telephone Number	:	442-347-7418
Fax Number	:	888-972-1912

Provider Business Practice Location Address
First Line	:	3559 E SOUTH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4519
Country	:	US
Telephone Number	:	562-354-4410
Fax Number	:	888-972-1912

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

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	08/29/2023

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