Provider Demographics
NPI:1225001852
Name:KLINGNER, MARY CELESTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CELESTE
Last Name:KLINGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E. JOHNSON AVE.
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:219 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9160
Practice Address - Country:US
Practice Address - Phone:509-682-2511
Practice Address - Fax:509-682-2515
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042305207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0196784OtherL&I
WA835045Medicaid
WA0196784OtherL&I
WA8853541Medicare ID - Type Unspecified