Provider Demographics
NPI:1942211875
Name:DRAKE, CELESTINE SALLY (NP)
Entity Type:Individual
Prefix:
First Name:CELESTINE
Middle Name:SALLY
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-255-7496
Mailing Address - Fax:315-255-7143
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-255-7496
Practice Address - Fax:315-255-7143
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner