| NPI | 1497461990 |
|---|---|
| Former Name | KELLY RAE NORTHWAY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9891) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302580) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-01-27 |