Provider Demographics
NPI:1811224215
Name:NOWOSIELSKI-BANKS, CELESTE REBECCA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:REBECCA
Last Name:NOWOSIELSKI-BANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:R
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1598479OtherGATEWAY MEDICARE ASSURED
PA2133903OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA1598479OtherGATEWAY MEDICARE ASSURED
PA267756FLTMedicare PIN