Individual
KELLIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
22101 MOROSS, DETROIT, MI 48226
(313) 343-4766
Mailing address
39086 VASSAR, STERLING HEIGHTS, MI 48313
(586) 532-7074
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704173942
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KM173942
BLUE CROSS OF MI
MI
Enumeration date
04/14/2006
Last updated
07/08/2007
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