Provider Demographics
NPI:1134807431
Name:WERNER, KELSI MARIE
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:MARIE
Last Name:WERNER
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 1:1911 SELBY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5808
Mailing Address - Country:US
Mailing Address - Phone:818-915-8542
Mailing Address - Fax:
Practice Address - Street 1:13958 LA MAIDA ST
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-1907
Practice Address - Country:US
Practice Address - Phone:818-915-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program