Individual provider · NPI-1

Kelly Bush

Community Health Worker · Farmington Hills, MI

NPI number1689060014
StatusActive
Last updated in NPPESApr 13, 2015

Details

NPI
1689060014
Entity type
Individual (NPI-1)
Name
Kelly Bush
Sex
Female
Sole proprietor
No
Enumeration date
Apr 13, 2015
Last updated
Apr 13, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172V00000X Community Health WorkerL2551518MIYes

Practice location

32910 W 13 Mile Rd
Bldg. A, Suite 100
Farmington Hills, MI 48334-1980

Phone 248-539-3390

Mailing address

32910 W 13 Mile Rd
Bldg. A, Suite 100
Farmington Hills, MI 48334-1980

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