Individual
KELLEE SYRENA GRIMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
12652 SANTA ROSA DR, DETROIT, MI 48238-3126
(313) 629-5541
Mailing address
12652 SANTA ROSA DR, DETROIT, MI 48238-3126
(313) 629-5541
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110721
MI
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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