MEDICARE: CELESTINE MYERS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704159897	MI

General Provider Information

NPI Number	:	1780308494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTINE MYERS RN

Provider Business Mailing Address
First Line	:	15892 ORCHARD LN
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-5215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11475 E OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-3226
Country	:	US
Telephone Number	:	313-737-0018
Fax Number	:	586-200-3885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	09/27/2022

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