Basic Information
| Provider Information | |||||||||
| NPI: | 1407248586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | B.S.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189561463 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 MUNRO AVE | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098986964 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 02/25/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 2280939 | MA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.