Individual
KELLY ELLEN DEWENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3097 PRAIRIE ST SW, GRANDVILLE, MI 49418-2000
(616) 531-9973
Mailing address
7652 FINCH AVE, JENISON, MI 49428-9147
(616) 690-4107
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704154590
MI
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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