| Doctor Name: | KELLI NICOLE FOGARTY |
| NPI Number: | 1003121120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 4704254681 |
| Business Practice Address: | 2087 Hidden Ln Leonard, MI - 483673225 |
| Business Phone Number: | 7346249938 |
| Business Fax Number: | |
| Mailing Address: | 765 Kestrel Ridge Dr, SOUTH LYON |
| State: | MI |
| Postal Code: | 481782027 |
| Phone Number: | 7346249938 |
| Fax Number: | |
| NPI Enumeration Date: | 08/12/2010 |
| NPI Last Update Date: | 08/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WH0200X |
| License Number: | 4704254681 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Home Health |
| Taxonomy Definition: | |