Provider Demographics
NPI:1407866320
Name:WARD, KELLI (RN, CNM)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-0010
Mailing Address - Country:US
Mailing Address - Phone:530-538-9410
Mailing Address - Fax:530-538-9411
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:SUITE 370
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6131
Practice Address - Country:US
Practice Address - Phone:530-538-9410
Practice Address - Fax:530-538-9411
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1680OtherRN, CNM