| NPI | 1669836979 |
|---|---|
| Former Name | KELLY ROE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704264368) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704264368) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2022-09-29 |