Provider Demographics
NPI:1649489915
Name:FERNANDES, CECELIA MARIA (RN, LAC)
Entity type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:MARIA
Last Name:FERNANDES
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 E DELANO DR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1118
Mailing Address - Country:US
Mailing Address - Phone:520-421-1862
Mailing Address - Fax:
Practice Address - Street 1:1172 E DELANO DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-1118
Practice Address - Country:US
Practice Address - Phone:520-421-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187235163W00000X
AZ127775163W00000X
AZ0384171100000X
MA211068171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist