Provider Demographics
NPI:1801282371
Name:CELMO, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CELMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28919 HOLLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-7406
Mailing Address - Country:US
Mailing Address - Phone:586-219-7764
Mailing Address - Fax:
Practice Address - Street 1:28919 HOLLYWOOD ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-7406
Practice Address - Country:US
Practice Address - Phone:586-219-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110730164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse