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General NPI Number Information
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NPI Number | 1700637774
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Entity Type | Individual
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Provider Name | JENNIFER LEE KELLEY CNS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 1540 E HOSPITAL DR SPC 4242
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City | ANN ARBOR
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State | MI
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Zip | 48109-4242
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Country | US
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Telephone | 734-936-8058
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Fax |
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Provider Business Mailing Address
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Address Line | 8563 BERGIN RD
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City | HOWELL
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State | MI
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Zip | 48843-9032
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Country | US
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Telephone | 734-936-8058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0200X
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Taxonomy Name | Pediatric Clinical Nurse Specialist
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License Number | 4704287974
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License Number State | MI
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