Provider Demographics
NPI:1952792640
Name:VANOVERBEKE, KELLI M (NP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:M
Last Name:VANOVERBEKE
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28963 LITTLE MACK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ST CLR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3017
Mailing Address - Country:US
Mailing Address - Phone:586-447-0228
Mailing Address - Fax:586-498-0707
Practice Address - Street 1:28963 LITTLE MACK AVE STE 101
Practice Address - Street 2:
Practice Address - City:ST CLR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081
Practice Address - Country:US
Practice Address - Phone:586-447-0700
Practice Address - Fax:586-498-0707
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704165386363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology