=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346643954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELESTE RENEE GROENENBERG CPM, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2014
-----------------------------------------------------
Last Update Date | 08/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 WERKNER ROAD
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-747-0205
-----------------------------------------------------
Fax | 734-480-8827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 WERKNER ROAD
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-9145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-747-0205
-----------------------------------------------------
Fax | 734-480-8827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 7601000033
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------