| NPI | 1558939702 |
|---|---|
| Former Name | KELLY DOROTHY PAVILAITIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025793) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F347771) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2023-10-04 |