Provider Demographics
NPI:1720363005
Name:BUCHAKLIAN, CELESTE MIRANDA (APNP)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:MIRANDA
Last Name:BUCHAKLIAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 W WYNDRIDGE DRIVE
Mailing Address - Street 2:206
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-8610
Mailing Address - Country:US
Mailing Address - Phone:414-758-3547
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVENUE
Practice Address - Street 2:ST. LUKES MEDICAL CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-649-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4530-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner