Provider Demographics
NPI:1720188550
Name:ENGSTROM, KELLY AIMEE-RECTOR (CNM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:AIMEE-RECTOR
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:RECTOR-ENGSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:7974 AMARGOSA DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9103
Mailing Address - Country:US
Mailing Address - Phone:760-815-7364
Mailing Address - Fax:
Practice Address - Street 1:320 SANTA FE DR STE 300
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5140
Practice Address - Country:US
Practice Address - Phone:760-901-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234751367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife