Provider Demographics
NPI:1164940375
Name:BLANEY, KAELEY RAE
Entity Type:Individual
Prefix:
First Name:KAELEY
Middle Name:RAE
Last Name:BLANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 MEMORIAL DR APT 208
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-5304
Mailing Address - Country:US
Mailing Address - Phone:920-634-4498
Mailing Address - Fax:
Practice Address - Street 1:2088 MEMORIAL DRIVE #208
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-634-4498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program