Anderson, Kelley Marie

Anderson, Kelley Marie is an sole proprietor health care provider with primary practice located at 500 White Road , Brockport NY 14420-9610. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Anderson, Kelley Marie can be contacted via phone (585) 944-4467.

Contact Information

Primary practice address
500 White Road Brockport NY 14420-9610
Phone: (585) 944-4467
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X 322767-1 New York

Profile Details

NPI number 1710437892
LBN Legal business name Anderson, Kelley Marie
Credentials Licensed Practical Nurse (LPN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 12th, 2016
Last updated May 19th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710437892 NPPES
New York MEDICAID 04550001

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