Provider Demographics
NPI:1477163590
Name:MENZER, CELESTE RENEA (PA)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:RENEA
Last Name:MENZER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:RENEA
Other - Last Name:FLOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17183 I 45 S STE 390B
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3313
Mailing Address - Country:US
Mailing Address - Phone:936-270-3680
Mailing Address - Fax:
Practice Address - Street 1:17183 I 45 S STE 390B
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3313
Practice Address - Country:US
Practice Address - Phone:936-270-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15036363A00000X, 363AS0400X, 363A00000X
363AS0400X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program