Provider Demographics
NPI:1659959096
Name:MURNANE, KELLI COLLEEN (COSMETOLOGY)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:COLLEEN
Last Name:MURNANE
Suffix:
Gender:F
Credentials:COSMETOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 CAMARILLO SPRINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9449
Mailing Address - Country:US
Mailing Address - Phone:818-389-4152
Mailing Address - Fax:
Practice Address - Street 1:795 CAMARILLO SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9449
Practice Address - Country:US
Practice Address - Phone:818-389-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK5591301744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management