Basic Information
| Provider Information | |||||||||
| NPI: | 1508036351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 916 PACIFIC AVE | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253036500 | ||||||||
| FaxNumber: | 4253036550 | ||||||||
| Practice Location | |||||||||
| Address1: | 916 PACIFIC AVE | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982014147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253036500 | ||||||||
| FaxNumber: | 4253036550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00056035 | WA | Y | Nursing Service Providers | Registered Nurse | 163WC0400X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Case Management | 163WC1500X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Community Health | 163WG0000X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | General Practice | 163WH0200X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Home Health | 163WL0100X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 163WM0102X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Maternal Newborn | 163WN1003X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Nutrition Support | 163WP0200X | RN00056035 | WA | N | Nursing Service Providers | Registered Nurse | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | RN00056035 | 01 | WA | RN LICENSE NUMBER | OTHER |