Provider Demographics
NPI:1568961514
Name:WALKOS, CELESTE MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:WALKOS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:MARIE
Other - Last Name:WALKOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:832 MANZANO AVE SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6262
Mailing Address - Country:US
Mailing Address - Phone:505-400-9941
Mailing Address - Fax:
Practice Address - Street 1:127 SANDOVAL RD SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7320
Practice Address - Country:US
Practice Address - Phone:505-865-3373
Practice Address - Fax:505-865-2078
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily