Healthcare Provider Details

I. General information

NPI: 1316785900
Provider Name (Legal Business Name): MARIA ROSE MACAULEY DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2813 KENMORE RD
BERKLEY MI
48072-1588
US

IV. Provider business mailing address

2813 KENMORE RD
BERKLEY MI
48072-1588
US

V. Phone/Fax

Practice location:
  • Phone: 248-884-8995
  • Fax:
Mailing address:
  • Phone: 248-884-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704333780
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: