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1013332105
KELLY VANVICKLE
STAPLES, MN
NPI
1013332105
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LW0102X Nurse Practitioner Women's Health
(Licence: MN R147459-6)
Enumeration Date
2014-02-26
Last Update Date
2021-09-15
Business Address
KELLY VANVICKLE
49725 COUNTY 83
STAPLES, MN 56479-5280
Phone number: 218-894-1515
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Mailing Address
KELLY VANVICKLE
PO BOX 65
CROSSLAKE, MN 56442-0065
Phone number:
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