Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 4301064775 | MI |
NPI | 1144237066 |
---|---|
Provider Name | Kelly Delongpre |
First Address | Muskegon, MI 49443-1847 |
Second Address | Shelby, MI 49455-1228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 24/02/2015 |