Healthcare Provider Details

I. General information

NPI: 1023786720
Provider Name (Legal Business Name): MRS. MARIA D CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S WASHINGTON AVE
LANSING MI
48910-0828
US

IV. Provider business mailing address

2025 S WASHINGTON AVE
LANSING MI
48910-0828
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-8082
  • Fax:
Mailing address:
  • Phone: 517-272-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703110013
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: