Healthcare Provider Details

I. General information

NPI: 1942445473
Provider Name (Legal Business Name): DENISE DAWN KELLEPOUREY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

27635 WEDDEL AVE
BROWNSTOWN TWP MI
48183-5915
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax:
Mailing address:
  • Phone: 734-467-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704157022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: