Provider Demographics
NPI:1114463403
Name:TUPUA, CELIANA (LPN)
Entity type:Individual
Prefix:
First Name:CELIANA
Middle Name:
Last Name:TUPUA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15312 CARTER CT SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8575
Mailing Address - Country:US
Mailing Address - Phone:253-683-0103
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:ATTN: MCHJ-CLQ-C MADIGAN ARMY MEDICAL CENTER,
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98413-1100
Practice Address - Country:US
Practice Address - Phone:360-968-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60687182164W00000X
WARN61050233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse