Provider Demographics
NPI:1447057088
Name:KELSO, DEMI
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:
Last Name:KELSO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23955 EDINBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4810
Mailing Address - Country:US
Mailing Address - Phone:313-241-1331
Mailing Address - Fax:
Practice Address - Street 1:23955 EDINBURGH ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-4810
Practice Address - Country:US
Practice Address - Phone:313-241-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula