Provider Demographics
NPI:1407683733
Name:TORRES, KELLI A
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:TORRES
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 1:24017 E BROADWAY CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9673
Mailing Address - Country:US
Mailing Address - Phone:509-863-1702
Mailing Address - Fax:
Practice Address - Street 1:24017 E BROADWAY CT
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-9673
Practice Address - Country:US
Practice Address - Phone:509-863-1702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider