Healthcare Provider Details

I. General information

NPI: 1750781373
Provider Name (Legal Business Name): ANASTASIA KANELLOPOULOS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W MICHIGAN AVE SUITE 300
JACKSON MI
49201-1900
US

IV. Provider business mailing address

744 W MICHIGAN AVE SUITE 300
JACKSON MI
49201-1900
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0600
  • Fax: 517-768-0606
Mailing address:
  • Phone: 517-768-0600
  • Fax: 517-768-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704294210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: