Healthcare Provider Details

I. General information

NPI: 1316876774
Provider Name (Legal Business Name): KELSEY LYNN OLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25631 LITTLE MACK AVE STE 205
SAINT CLAIR SHORES MI
48081-2108
US

IV. Provider business mailing address

16724 ABELA DR
CLINTON TOWNSHIP MI
48035-2255
US

V. Phone/Fax

Practice location:
  • Phone: 586-443-2930
  • Fax:
Mailing address:
  • Phone: 586-596-0282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04260568
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: