Doctor Name: | DIANE M KELLY |
NPI Number: | 1083672406 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA0005268 |
Business Practice Address: | 7902 Ne St Johns Rd Vancouver, WA - 986651094 |
Business Phone Number: | 3605736424 |
Business Fax Number: | |
Mailing Address: | 9105 Ne 25th Ave, VANCOUVER |
State: | WA |
Postal Code: | 986659057 |
Phone Number: | 3605738183 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA0005268 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |