Provider Demographics
NPI:1225033491
Name:CELIK, JUDITH (NP)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:CELIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 E MAIN ST
Mailing Address - Street 2:# 220
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8928
Mailing Address - Country:US
Mailing Address - Phone:602-390-6655
Mailing Address - Fax:480-924-8256
Practice Address - Street 1:6040 E MAIN ST
Practice Address - Street 2:# 220
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8928
Practice Address - Country:US
Practice Address - Phone:602-390-6655
Practice Address - Fax:480-924-8256
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN088702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ62305OtherMERIDIAN
AZ539893Medicaid
AZP08650Medicare UPIN