Provider Demographics
NPI:1396593331
Name:FICHTER, KELLI MELEESE (LVN)
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:MELEESE
Last Name:FICHTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:MELEESE
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:187 SOUTHAMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3322
Mailing Address - Country:US
Mailing Address - Phone:714-600-5288
Mailing Address - Fax:
Practice Address - Street 1:187 SOUTHAMPTON WAY
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3322
Practice Address - Country:US
Practice Address - Phone:714-600-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA732150164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse