Individual
MRS. KELLY RENET DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
416 WOODLAND DR, SANDUSKY, MI 48471-1047
(810) 202-6022
(810) 682-4026
Mailing address
2690 GERMANIA RD, MARLETTE, MI 48453-8965
(810) 577-7395
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601003127
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601003127
STATE LICENSE NUMBER
MI
Enumeration date
01/02/2007
Last updated
11/19/2024
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