Provider Demographics
NPI:1649681735
Name:JUSTICE, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JUSTICE
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 1:370 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5410
Mailing Address - Country:US
Mailing Address - Phone:440-308-7317
Mailing Address - Fax:440-444-1056
Practice Address - Street 1:370 E 41ST ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5410
Practice Address - Country:US
Practice Address - Phone:440-308-7317
Practice Address - Fax:440-444-1056
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide