Provider Demographics
NPI:1699806307
Name:FERRIS, CELESTE (RN)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 GRAND AVE # 115
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1765
Mailing Address - Country:US
Mailing Address - Phone:562-570-4256
Mailing Address - Fax:562-570-4072
Practice Address - Street 1:2525 GRAND AVE # 115
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1765
Practice Address - Country:US
Practice Address - Phone:562-570-4256
Practice Address - Fax:562-570-4072
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN388295163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory