Provider Demographics
NPI:1538886312
Name:CELESTRA, MARIEBEL FLORES
Entity type:Individual
Prefix:
First Name:MARIEBEL
Middle Name:FLORES
Last Name:CELESTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIEBEL
Other - Middle Name:PICONES
Other - Last Name:CELESTRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE CASE MANAGER
Mailing Address - Street 1:1226 BURNSIDE PL
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8810
Mailing Address - Country:US
Mailing Address - Phone:253-310-6636
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 13815 F ST.
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-967-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00164529163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management