Provider Demographics
NPI:1407502420
Name:CHRISTIANSEN, CELESTE RENEE (FNP-S)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:RENEE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:FNP-S
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:RENEE
Other - Last Name:ETHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 E LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2394
Mailing Address - Country:US
Mailing Address - Phone:801-830-7227
Mailing Address - Fax:
Practice Address - Street 1:3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-3903
Practice Address - Country:US
Practice Address - Phone:801-626-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6072992-3102163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse