Provider Demographics
NPI:1356721674
Name:GREEN-PATES, CELESTIAL
Entity type:Individual
Prefix:
First Name:CELESTIAL
Middle Name:
Last Name:GREEN-PATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 EASTOVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2831
Mailing Address - Country:US
Mailing Address - Phone:662-402-5327
Mailing Address - Fax:
Practice Address - Street 1:203 EASTOVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2831
Practice Address - Country:US
Practice Address - Phone:662-402-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker