Provider Demographics
NPI:1649522277
Name:DIN, KELLY LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:DIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:SEBOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:229 CORK TREE LN UNIT P
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5977
Mailing Address - Country:US
Mailing Address - Phone:301-922-3852
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0004
Practice Address - Country:US
Practice Address - Phone:301-295-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR179105163W00000X
DCRN1008834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse