Provider Demographics
NPI:1548001654
Name:MADER, KELSEY (MD)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:MADER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WSU FAMILY MEDICINE RESIDENCY CENTER
Mailing Address - Street 2:825 SE BISHOP BLVD STE 401
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:509-336-7720
Mailing Address - Fax:
Practice Address - Street 1:WSU FAMILY MEDICINE RESIDENCY CENTER
Practice Address - Street 2:825 SE BISHOP BLVD STE 401
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163
Practice Address - Country:US
Practice Address - Phone:509-336-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program