Provider Demographics
NPI:1245560986
Name:UNDER BAGGAGE, ALBERTA CELESTE (RN)
Entity Type:Individual
Prefix:MS
First Name:ALBERTA
Middle Name:CELESTE
Last Name:UNDER BAGGAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8114
Mailing Address - Country:US
Mailing Address - Phone:605-355-2333
Mailing Address - Fax:605-355-2553
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-355-2333
Practice Address - Fax:605-355-2553
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR017490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0140070OtherMEDICAID INPATIENT
SD5549050Medicaid
SD5549050Medicaid
SD0140070OtherMEDICAID INPATIENT
SD430082Medicare Oscar/Certification