Healthcare Provider Details

I. General information

NPI: 1982195178
Provider Name (Legal Business Name): NATALIE KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

IV. Provider business mailing address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-7340
  • Fax: 734-243-5506
Mailing address:
  • Phone: 734-243-7340
  • Fax: 734-243-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802089925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: