Provider Demographics
NPI:1417313800
Name:MACATULA, CLARITA (ANP-BC)
Entity Type:Individual
Prefix:
First Name:CLARITA
Middle Name:
Last Name:MACATULA
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 UNION LAKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2200
Mailing Address - Country:US
Mailing Address - Phone:248-363-7109
Mailing Address - Fax:
Practice Address - Street 1:1990 UNION LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2200
Practice Address - Country:US
Practice Address - Phone:248-363-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2014021884363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care