Provider Demographics
NPI:1649901620
Name:NIPPER, CELINE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:MARIE
Last Name:NIPPER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 LATHAM ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1741
Mailing Address - Country:US
Mailing Address - Phone:949-783-7012
Mailing Address - Fax:
Practice Address - Street 1:4240 LATHAM ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1741
Practice Address - Country:US
Practice Address - Phone:949-783-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2025-02-04
Deactivation Date:2022-11-28
Deactivation Code:
Reactivation Date:2022-12-20
Provider Licenses
StateLicense IDTaxonomies
CARN95187070163W00000X
CA95023122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse