Individual
SHANNON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1619 BUSH AVE, MUSKEGON, MI 49442-5348
(231) 670-4510
Mailing address
1619 BUSH AVE, MUSKEGON, MI 49442-5348
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704178775
MI
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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