Provider Demographics
NPI:1508158288
Name:LI, KALIE NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:KALIE
Middle Name:NICOLE
Last Name:LI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KALIE
Other - Middle Name:NICOLE
Other - Last Name:BRENNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2900
Mailing Address - Country:US
Mailing Address - Phone:707-251-1850
Mailing Address - Fax:707-251-1860
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2900
Practice Address - Country:US
Practice Address - Phone:707-251-1850
Practice Address - Fax:707-251-1860
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14112207V00000X
NY63056390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program