Provider Demographics
NPI:1962698936
Name:PIETTE, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PIETTE
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 1:306 W SUPERIOR ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1803
Mailing Address - Country:US
Mailing Address - Phone:218-722-4379
Mailing Address - Fax:
Practice Address - Street 1:306 W SUPERIOR ST
Practice Address - Street 2:SUITE 403
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1803
Practice Address - Country:US
Practice Address - Phone:218-722-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 138185-4163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health