Individual
MRS. KELLIE MARIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1200 E MICHIGAN AVE STE 415, LANSING, MI 48912-1897
(517) 484-2760
(517) 484-9370
Mailing address
1200 E MICHIGAN AVE STE 415, LANSING, MI 48912-1897
(517) 484-2760
(517) 484-9370
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
363AM0700X
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601004711
BCBS STATE LICENSE
MI
Enumeration date
05/26/2006
Last updated
01/21/2013
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