Provider Demographics
NPI:1083684773
Name:BLANKEN, CELESTE (DO)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:
Last Name:BLANKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4589
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4589
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4868207Q00000X
ORDO165427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0635514OtherGROUP TAX FOR BILLING NORTH BEND MEDICAL CENTER
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
ORDO165427OtherOREGON MEDICAL BOARD
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
OR16113OtherGROUP MEDICAID NORTH BEND MEDICAL CENTER
OR500671822Medicaid
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER