Healthcare Provider Details

I. General information

NPI: 1518678994
Provider Name (Legal Business Name): NOELLE ANN CELIS BURKHOLDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOELLE ANN BUCARIZA NP

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 WHITE CIR
MARIETTA GA
30066-5835
US

IV. Provider business mailing address

1810 WHITE CIR
MARIETTA GA
30066-5835
US

V. Phone/Fax

Practice location:
  • Phone: 678-797-6820
  • Fax:
Mailing address:
  • Phone: 478-228-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN271215
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN271215
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: