Provider Demographics
NPI:1396378378
Name:MILLER, KELSEY D (RN)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:D
Other - Last Name:SCHLEDEWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1107 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MINATARE
Mailing Address - State:NE
Mailing Address - Zip Code:69356-3994
Mailing Address - Country:US
Mailing Address - Phone:303-656-6032
Mailing Address - Fax:
Practice Address - Street 1:1107 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MINATARE
Practice Address - State:NE
Practice Address - Zip Code:69356-3994
Practice Address - Country:US
Practice Address - Phone:308-783-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68433163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool