Provider Demographics
NPI:1538565403
Name:PREVITE, CELESTE (CNP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:PREVITE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:419-281-3077
Mailing Address - Fax:419-281-2905
Practice Address - Street 1:5000 E MARKET ST STE 30
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2259
Practice Address - Country:US
Practice Address - Phone:330-856-9699
Practice Address - Fax:330-856-9935
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16715-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner