| NPI | 1093049165 |
|---|---|
| Former Name | KELLY LYNNE THERIAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2261903) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: MA RN2261903) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2017-11-07 |