Individual
KELLI AMANDA FUGATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7755 FREDERICK ST, MAYBEE, MI 48159-9697
(734) 217-9694
Mailing address
7755 FREDERICK ST, MAYBEE, MI 48159-9697
(734) 217-9694
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703125158
MI
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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