Provider Demographics
NPI:1487836946
Name:WILSON-RAMSEUR, CELESTE EDANA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:EDANA
Last Name:WILSON-RAMSEUR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1826
Mailing Address - Country:US
Mailing Address - Phone:315-507-2211
Mailing Address - Fax:315-507-2211
Practice Address - Street 1:610 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1826
Practice Address - Country:US
Practice Address - Phone:315-507-2211
Practice Address - Fax:315-507-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02668468Medicaid