Individual
KELLY MARIE MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
703 N MCEWAN ST, CLARE, MI 48617-1440
(898) 802-5000
Mailing address
703 N MCEWAN ST, CLARE, MI 48617-1440
(586) 322-9126
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704254007
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704254007
MI
Other
Enumeration date
12/11/2011
Last updated
09/04/2013
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