Healthcare Provider Details

I. General information

NPI: 1336733351
Provider Name (Legal Business Name): LINDSAY ANNE KASTELAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47818 VAN DYKE AVE
SHELBY TOWNSHIP MI
48317-3373
US

IV. Provider business mailing address

47818 VAN DYKE AVE
SHELBY TOWNSHIP MI
48317-3373
US

V. Phone/Fax

Practice location:
  • Phone: 586-323-3620
  • Fax:
Mailing address:
  • Phone: 586-323-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704298985
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: