Healthcare Provider Details

I. General information

NPI: 1558770602
Provider Name (Legal Business Name): ROSEMARIE MACERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2014
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

IV. Provider business mailing address

3990 JOHN R ST
DETROIT MI
48201-2018
CA

V. Phone/Fax

Practice location:
  • Phone: 313-745-3356
  • Fax:
Mailing address:
  • Phone: 313-745-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704275925
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704275925
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: