Provider Demographics
NPI:1841634029
Name:KRUZEL, KELLI J (PA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:KRUZEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2408
Mailing Address - Country:US
Mailing Address - Phone:401-757-6160
Mailing Address - Fax:401-349-0840
Practice Address - Street 1:400 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2408
Practice Address - Country:US
Practice Address - Phone:401-757-6160
Practice Address - Fax:401-349-0840
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016451363A00000X
RIPA00911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant