Provider Demographics
NPI:1942458260
Name:KELSO, SARAH E (APN/CPNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:KELSO
Suffix:
Gender:F
Credentials:APN/CPNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:FEDEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 ALQER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3530
Mailing Address - Country:US
Mailing Address - Phone:616-243-9515
Mailing Address - Fax:616-243-1815
Practice Address - Street 1:733 ALQER ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3530
Practice Address - Country:US
Practice Address - Phone:616-243-9515
Practice Address - Fax:616-243-1815
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041338008163WP0200X
IL209007232363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics