Individual
KELLY LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
54460 BLUE CLOUD DR, SHELBY TWP, MI 48315-1226
(586) 703-3018
Mailing address
54460 BLUE CLOUD DR, SHELBY TWP, MI 48315-1226
(586) 703-3018
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704281314
MI
Other
Enumeration date
09/15/2016
Last updated
10/01/2020
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