NPI 1043933021

Kellen Joseph Ibiza, CNC

Practitioner Health & Wellness Coach North Prairie, WI

Practice location

Address: 108 N Harrison St, North Prairie, WI 53153-9791
Phone: (312) 826-6073

Registered specialties

Health & Wellness Coach Primary

Other Service Providers Taxonomy 171400000X

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Registry record

NPI: 1043933021
Entity type: Individual
Sex (as registered): Male
NPI issued: 23 Sep 2022
Record last updated: 23 Sep 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.