Healthcare Provider Details

I. General information

NPI: 1740273192
Provider Name (Legal Business Name): CELESTE BACZESKI SUMINSBY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 RIVERSIDE PLAZA LN NW STE A
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6320 RIVERSIDE PLAZA LN NW STE B
ALBUQUERQUE NM
87120-1710
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6168
  • Fax: 505-792-1978
Mailing address:
  • Phone: 505-843-6168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNP-02043
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: