| Doctor Name: | ANGELA KELLO |
| NPI Number: | 1255786968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 4704233317 |
| Business Practice Address: | 4528 Cloverdale Ct Lake Orion, MI - 483590003 |
| Business Phone Number: | 5869961855 |
| Business Fax Number: | |
| Mailing Address: | 4528 Cloverdale Ct, LAKE ORION |
| State: | MI |
| Postal Code: | 483590003 |
| Phone Number: | 5869961855 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2016 |
| NPI Last Update Date: | 05/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704233317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |