Provider Demographics
NPI:1124669908
Name:HOYER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7211 MIDNIGHT CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942
Mailing Address - Country:US
Mailing Address - Phone:920-640-0948
Mailing Address - Fax:
Practice Address - Street 1:W7211 MIDNIGHT CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942
Practice Address - Country:US
Practice Address - Phone:920-640-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider