Provider Demographics
NPI:1023379393
Name:FINE, CELESTE JOLIE (NP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:JOLIE
Last Name:FINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:JOLIE
Other - Last Name:MICHAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3507 S MERCY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0441
Mailing Address - Country:US
Mailing Address - Phone:480-926-0644
Mailing Address - Fax:480-926-0645
Practice Address - Street 1:3507 S MERCY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-926-0644
Practice Address - Fax:480-926-0645
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily