Individual
MRS. KELCIE ANN WAACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3 HERITAGE CENTER, SOUTHGATE, MI 48195
(734) 283-3222
(734) 283-4006
Mailing address
19169 HANNAN RD, NEW BOSTON, MI 48164-9371
(313) 605-3418
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4704333571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F04210455
—
MI
Enumeration date
05/03/2021
Last updated
12/08/2023
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