Individual
KELLY GARDINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12871 E JEFFERSON AVE, DETROIT, MI 48215-2754
(313) 821-3900
(313) 217-4590
Mailing address
12871 E JEFFERSON AVE, DETROIT, MI 48215-2754
(313) 821-3900
(313) 217-4590
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704170979
MI
Other
Enumeration date
06/15/2006
Last updated
02/25/2020
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