Provider Demographics
NPI:1134715162
Name:PELLEGRINO, KALI (RN)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E THOMAS RD UNIT 412
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1195
Mailing Address - Country:US
Mailing Address - Phone:203-231-1506
Mailing Address - Fax:
Practice Address - Street 1:2840 N DYSART RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2338
Practice Address - Country:US
Practice Address - Phone:623-536-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247797163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse