Provider Demographics
NPI:1992574370
Name:REMBOWSKI, KELLI JILL (BBA, CAC, CHW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:JILL
Last Name:REMBOWSKI
Suffix:
Gender:F
Credentials:BBA, CAC, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALE
Mailing Address - State:MI
Mailing Address - Zip Code:48739-9246
Mailing Address - Country:US
Mailing Address - Phone:989-728-2800
Mailing Address - Fax:989-728-2803
Practice Address - Street 1:436 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739-9246
Practice Address - Country:US
Practice Address - Phone:989-728-2800
Practice Address - Fax:989-728-2803
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker