Provider Demographics
NPI:1750539409
Name:NEDESCU, KELLY LORRAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LORRAINE
Last Name:NEDESCU
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 1:80 CRANBURNE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4902
Mailing Address - Country:US
Mailing Address - Phone:716-810-9403
Mailing Address - Fax:
Practice Address - Street 1:170 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2414
Practice Address - Country:US
Practice Address - Phone:716-856-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-07
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629861-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health