Provider Demographics
NPI:1609270180
Name:MURRAY, KELLI ANN (LPN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9324
Mailing Address - Country:US
Mailing Address - Phone:585-739-1452
Mailing Address - Fax:
Practice Address - Street 1:1147 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9324
Practice Address - Country:US
Practice Address - Phone:585-739-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266697164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse