Provider Demographics
NPI:1518187905
Name:COFFELT, CELESTE LOUISE (RN, BSN,B,S,)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:LOUISE
Last Name:COFFELT
Suffix:
Gender:F
Credentials:RN, BSN,B,S,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W FURNACE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2215
Mailing Address - Country:US
Mailing Address - Phone:410-222-6416
Mailing Address - Fax:410-222-6419
Practice Address - Street 1:615 W FURNACE BRANCH RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2215
Practice Address - Country:US
Practice Address - Phone:410-222-6416
Practice Address - Fax:410-222-6419
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124594163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool