Provider Demographics
NPI:1225654585
Name:KELLY, DEANA ASHLEY (RN)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:ASHLEY
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 GANNETT RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1208
Mailing Address - Country:US
Mailing Address - Phone:617-529-0789
Mailing Address - Fax:
Practice Address - Street 1:257 GANNETT RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1208
Practice Address - Country:US
Practice Address - Phone:617-529-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294218163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse