Provider Demographics
NPI:1366604993
Name:KELLENBARGER, LAURA LEE (NEONATAL NURSE PRACT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:KELLENBARGER
Suffix:
Gender:F
Credentials:NEONATAL NURSE PRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WINTER STREET SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3919
Mailing Address - Country:US
Mailing Address - Phone:503-562-5660
Mailing Address - Fax:503-562-3074
Practice Address - Street 1:939 OAK STREET
Practice Address - Street 2:NEONATAL INTENSIVE CARE FAMILY BIRTH CENTER
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3919
Practice Address - Country:US
Practice Address - Phone:503-562-5660
Practice Address - Fax:503-562-3074
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2007500055NP NNP PP363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal