Provider Demographics
NPI:1386016863
Name:CASACELI, MARIA (CNM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:CASACELI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29751 LITTLE MACK AVE
Mailing Address - Street 2:#B
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6503
Mailing Address - Country:US
Mailing Address - Phone:586-415-6200
Mailing Address - Fax:
Practice Address - Street 1:21535 COLONY ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1841
Practice Address - Country:US
Practice Address - Phone:586-415-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704282937367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife