Individual
KELLI NICOLE FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2087 HIDDEN LN, LEONARD, MI 48367-3225
(734) 624-9938
Mailing address
765 KESTREL RIDGE DR, SOUTH LYON, MI 48178-2027
(734) 624-9938
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
4704254681
MI
Other
Enumeration date
08/12/2010
Last updated
08/31/2010
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