Healthcare Provider Details

I. General information

NPI: 1558971663
Provider Name (Legal Business Name): ARICA TANIE CASTEEL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 HAMILTON AVE
HIGHLAND PARK MI
48203-3243
US

IV. Provider business mailing address

12501 HAMILTON AVE
HIGHLAND PARK MI
48203-3243
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-1580
  • Fax: 313-865-1582
Mailing address:
  • Phone: 313-865-1580
  • Fax: 313-865-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703116652
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: