Healthcare Provider Details

I. General information

NPI: 1528506649
Provider Name (Legal Business Name): KELLI TURNER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 GRAND RIVER AVE
DETROIT MI
48204-2139
US

IV. Provider business mailing address

12740 GRAYFIELD ST
DETROIT MI
48223-3071
US

V. Phone/Fax

Practice location:
  • Phone: 313-834-5930
  • Fax:
Mailing address:
  • Phone: 313-729-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703084013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: