Provider Demographics
NPI:1679050827
Name:CELESTINE, MAILIN SUE (NP-C)
Entity Type:Individual
Prefix:
First Name:MAILIN
Middle Name:SUE
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 LADY LUCK CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5821
Mailing Address - Country:US
Mailing Address - Phone:719-200-1495
Mailing Address - Fax:
Practice Address - Street 1:2864 S CIRCLE DR STE 450
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4170
Practice Address - Country:US
Practice Address - Phone:719-776-8850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994000-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily