Provider Demographics
NPI:1093086480
Name:HICKMAN, CELESTE MOORE
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:MOORE
Last Name:HICKMAN
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 1:185 CLINTON AVE APT 12D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3511
Mailing Address - Country:US
Mailing Address - Phone:718-596-9316
Mailing Address - Fax:
Practice Address - Street 1:185 CLINTON AVE APT 12D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3511
Practice Address - Country:US
Practice Address - Phone:718-596-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254474-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse