Provider Demographics
NPI:1366038077
Name:CASSIN, CELESTE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:CASSIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:MARIE
Other - Last Name:CHAIMUKDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:10324 RIDGELAND AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1522
Mailing Address - Country:US
Mailing Address - Phone:708-997-9487
Mailing Address - Fax:
Practice Address - Street 1:10324 RIDGELAND AVE APT 203
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1522
Practice Address - Country:US
Practice Address - Phone:708-997-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043087046164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse