Provider Demographics
NPI:1063274124
Name:OBRIEN, KELLI (CNS CANDIDATE)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:CNS CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ELSMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-4105
Mailing Address - Country:US
Mailing Address - Phone:540-809-5784
Mailing Address - Fax:
Practice Address - Street 1:5 ELSMERE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4105
Practice Address - Country:US
Practice Address - Phone:540-809-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist