Provider Demographics
NPI:1730687633
Name:RAYMOUN, CELECIA P (FNP-BC)
Entity type:Individual
Prefix:
First Name:CELECIA
Middle Name:P
Last Name:RAYMOUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CELECIA
Other - Middle Name:P
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:700 MCCLELLAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1019
Mailing Address - Country:US
Mailing Address - Phone:518-374-2525
Mailing Address - Fax:518-386-3553
Practice Address - Street 1:700 MCCLELLAN ST STE 103
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1026
Practice Address - Country:US
Practice Address - Phone:518-374-2525
Practice Address - Fax:518-374-2533
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF01181028OtherFAMILY NURSE PRACTITIONER