Provider Demographics
NPI:1700629763
Name:KAMINSKI, KELSEY KRISTIN
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:KRISTIN
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:KRISTIN
Other - Last Name:VANBONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:842 CANYON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1560
Mailing Address - Country:US
Mailing Address - Phone:616-304-4529
Mailing Address - Fax:
Practice Address - Street 1:1169 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9674
Practice Address - Country:US
Practice Address - Phone:734-222-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator