Healthcare Provider Details

I. General information

NPI: 1336702562
Provider Name (Legal Business Name): STEPHANIE MICHELLE CASTELLANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 190
ROCHESTER HILLS MI
48307-6124
US

IV. Provider business mailing address

51738 LESHAN DR
CHESTERFIELD MI
48047-3178
US

V. Phone/Fax

Practice location:
  • Phone: 586-580-0760
  • Fax:
Mailing address:
  • Phone: 586-419-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704313742
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704313742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: