Individual
MRS. KELLY ANN SHANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3350 BRIARFIELD BLVD STE 300, MAUMEE, OH 43537-9502
(419) 452-2140
(419) 873-6327
Mailing address
801 ROSEHILL RD, JACKSON, MI 49202-1762
(517) 212-2008
(517) 212-2009
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN261639
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2207347
—
OH
Enumeration date
12/16/2005
Last updated
09/11/2023
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