Provider Demographics
NPI:1427393545
Name:CELESTIN, FULVIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:FULVIE
Middle Name:
Last Name:CELESTIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25924 148TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2904
Mailing Address - Country:US
Mailing Address - Phone:347-994-7079
Mailing Address - Fax:
Practice Address - Street 1:25924 148TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2904
Practice Address - Country:US
Practice Address - Phone:347-994-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY665003163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse