Provider Demographics
NPI:1023462488
Name:STRAZZANTE, KELLY (RD, PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:STRAZZANTE
Suffix:
Gender:F
Credentials:RD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10855 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-0210
Mailing Address - Country:US
Mailing Address - Phone:773-702-6222
Mailing Address - Fax:
Practice Address - Street 1:10855 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-0210
Practice Address - Country:US
Practice Address - Phone:219-407-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86056816133V00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered