Provider Demographics
NPI:1013672757
Name:QUICK BEAR, KELLI ELAINE
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ELAINE
Last Name:QUICK BEAR
Suffix:
Gender:F
Credentials:
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 625
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-0625
Mailing Address - Country:US
Mailing Address - Phone:701-421-1623
Mailing Address - Fax:
Practice Address - Street 1:2860 85TH AVE NW
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-5876
Practice Address - Country:US
Practice Address - Phone:701-421-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant