Provider Demographics
NPI:1881360790
Name:KELLEY, ZANE CORNEL
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:CORNEL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9698
Mailing Address - Country:US
Mailing Address - Phone:509-670-8634
Mailing Address - Fax:
Practice Address - Street 1:217 S BRADLEY ST
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9698
Practice Address - Country:US
Practice Address - Phone:509-670-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter