Doctor Name: | KELSEY BEAUPRE |
NPI Number: | 1154703593 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3606 - 23 |
Business Practice Address: | 975 Port Washington Rd Grafton, WI - 530249201 |
Business Phone Number: | 2623291000 |
Business Fax Number: | |
Mailing Address: | 1720 N Commerce St Apt 215, MILWAUKEE |
State: | WI |
Postal Code: | 532124043 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/22/2015 |
NPI Last Update Date: | 07/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 3606 - 23 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |