Provider Demographics
NPI:1124868864
Name:WOOLLEY, CELENE RACHELLE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:CELENE
Middle Name:RACHELLE
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 RED ROCK PARK NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2154
Mailing Address - Country:US
Mailing Address - Phone:505-402-6516
Mailing Address - Fax:
Practice Address - Street 1:4425 JUAN TABO BLVD NE STE 140
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2694
Practice Address - Country:US
Practice Address - Phone:505-332-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD2022012133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered