Provider Demographics
NPI:1568755510
Name:CELIA FORNO PSYCHIATRIC NURSE PRACTITIONER, LLC
Entity Type:Organization
Organization Name:CELIA FORNO PSYCHIATRIC NURSE PRACTITIONER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:520-240-2614
Mailing Address - Street 1:1203 JAMES ST
Mailing Address - Street 2:APARTMENT #102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2129
Mailing Address - Country:US
Mailing Address - Phone:520-240-2614
Mailing Address - Fax:
Practice Address - Street 1:1203 JAMES ST
Practice Address - Street 2:APARTMENT #102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2129
Practice Address - Country:US
Practice Address - Phone:520-240-2614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60164040363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty