Individual
KELLY JO BAUMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
401 S BALLENGER HWY, FLINT, MI 48532-3638
(810) 342-2728
Mailing address
2541 GORLAD ST, LAKE ORION, MI 48360-2203
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704221562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704221562
LICENSE
MI
Enumeration date
09/23/2015
Last updated
09/23/2015
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