Provider Demographics
NPI:1992215487
Name:CARELLI, CATHERINE SUSAN (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSAN
Last Name:CARELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2052
Mailing Address - Country:US
Mailing Address - Phone:517-303-1152
Mailing Address - Fax:
Practice Address - Street 1:5300 PATTERSON AVE SE STE 125
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-9627
Practice Address - Country:US
Practice Address - Phone:616-222-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156426163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health