Provider Demographics
NPI:1043743990
Name:COONS-JUEDES, KELLI MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MARIE
Last Name:COONS-JUEDES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:MARIE
Other - Last Name:COONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1317 E KEYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7195
Mailing Address - Country:US
Mailing Address - Phone:920-470-0644
Mailing Address - Fax:
Practice Address - Street 1:1317 E KEYSTONE LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7195
Practice Address - Country:US
Practice Address - Phone:920-470-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI192278-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse