Provider Demographics
NPI:1336793116
Name:DEVERAUX, CHELESTE MARIE (DEM)
Entity Type:Individual
Prefix:
First Name:CHELESTE
Middle Name:MARIE
Last Name:DEVERAUX
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 E HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3457
Mailing Address - Country:US
Mailing Address - Phone:801-317-3537
Mailing Address - Fax:
Practice Address - Street 1:569 E HOWARD DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3457
Practice Address - Country:US
Practice Address - Phone:801-317-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay