Healthcare Provider Details

I. General information

NPI: 1942127246
Provider Name (Legal Business Name): KELLI JO GUNTHORP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MAPLE ST
STURGIS MI
49091-1853
US

IV. Provider business mailing address

114 S MAPLE ST
STURGIS MI
49091-1853
US

V. Phone/Fax

Practice location:
  • Phone: 269-221-9716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number4704405151
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: