Provider Demographics
NPI:1326552266
Name:REMBERT, KELLEE
Entity Type:Individual
Prefix:
First Name:KELLEE
Middle Name:
Last Name:REMBERT
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 1:3106 JACKSON SQUARE CT APT 18103
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3262
Mailing Address - Country:US
Mailing Address - Phone:219-201-7235
Mailing Address - Fax:
Practice Address - Street 1:3106 JACKSON SQUARE CT APT 18103
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3262
Practice Address - Country:US
Practice Address - Phone:219-201-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant