Individual
KELLI LEIGH BUTERAKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18323 EAST RD, NEW LOTHROP, MI 48460-9612
(321) 624-2482
Mailing address
18323 EAST RD, NEW LOTHROP, MI 48460-9612
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703116678
MI
Other
Enumeration date
12/27/2019
Last updated
12/27/2019
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