Provider Demographics
NPI:1316648017
Name:BRESLIN, KELLI (RN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:BRESLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:543 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-9707
Mailing Address - Country:US
Mailing Address - Phone:607-795-2552
Mailing Address - Fax:
Practice Address - Street 1:543 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-9707
Practice Address - Country:US
Practice Address - Phone:607-795-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677654163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool