Provider Demographics
NPI:1932719788
Name:TRUCKENMILLER, CELESTE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARIE
Last Name:TRUCKENMILLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:MARIE
Other - Last Name:KRIENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-9043
Mailing Address - Country:US
Mailing Address - Phone:484-637-6262
Mailing Address - Fax:
Practice Address - Street 1:211 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-9043
Practice Address - Country:US
Practice Address - Phone:484-637-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN685773163W00000X
PASP022443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse