Healthcare Provider Details

I. General information

NPI: 1194502724
Provider Name (Legal Business Name): KELSEY LEIGH MARION RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY LEIGH POLLARD RN

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S MAPLE ST
ONSTED MI
49265-9580
US

IV. Provider business mailing address

255 S MAPLE ST
ONSTED MI
49265-9580
US

V. Phone/Fax

Practice location:
  • Phone: 517-260-8672
  • Fax:
Mailing address:
  • Phone: 517-260-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number4704315110
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: