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NPI Code Detail

MEDICARE: CATHERINE SUSAN CARELLI RN

MEDICARE:   CATHERINE SUSAN CARELLI  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WH0200XHome Health Registered Nurse4704156426MI

General Provider Information

NPI Number : 1992215487
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHERINE SUSAN CARELLI RN
Provider Business Mailing Address
First Line : 935 E SCOTT ST
Second Line :
City : GRAND LEDGE
State : MI
Zip : 48837-2052
Country : US
Telephone Number : 517-303-1152
Fax Number :
Provider Business Practice Location Address
First Line : 5300 PATTERSON AVE SE STE 125
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9627
Country : US
Telephone Number : 616-222-5601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2017
Last Update Date : 10/10/2017

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Directions to “ CATHERINE SUSAN CARELLI RN” Practice Location

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