Individual
DONNA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN NNP
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-3526
(248) 858-3532
Mailing address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-3526
(248) 858-3532
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
4704132319
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104868500
—
MI
01
—
500F328230
BCBSM GROUP PIN
MI
Enumeration date
07/24/2006
Last updated
07/09/2007
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