Individual
KELLY R NIEZURAWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6500 N HAWKINS HWY, MANITOU BEACH, MI 49253-9736
(734) 572-5777
Mailing address
PO BOX 175, MANITOU BEACH, MI 49253-0175
(517) 403-3771
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704187362
MI
Other
Enumeration date
02/25/2020
Last updated
06/27/2023
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