Provider Demographics
NPI:1376644559
Name:STANO, ROSE ANN CELESKEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANN CELESKEY
Last Name:STANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:ANN
Other - Last Name:CELESKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20040 GHESQUIERE CT
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2319
Mailing Address - Country:US
Mailing Address - Phone:313-343-5602
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:ST. JOHN HOSP. SUITE 212
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-642-9048
Practice Address - Fax:313-417-2718
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001426363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical