Provider Demographics
NPI:1457723231
Name:ROBINSON, CELESTE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:ROBINSON
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 1:15400 W MCNICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3724
Mailing Address - Country:US
Mailing Address - Phone:313-416-6262
Mailing Address - Fax:855-643-6164
Practice Address - Street 1:15400 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3724
Practice Address - Country:US
Practice Address - Phone:313-416-6262
Practice Address - Fax:855-643-6164
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191878363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care