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1407502420 NPI number — CELESTE RENEE CHRISTIANSEN FNP

NPI Number: 1407502420
Health Care Provider/Practitioner: CELESTE RENEE CHRISTIANSEN FNP

Information about “1407502420” NPI (CELESTE RENEE CHRISTIANSEN FNP) exists in 1407502420 in HTML format HTML  |  1407502420 in plain Text format TXT  |  1407502420 in PDF (Portable Document Format) PDF  |  1407502420 in an XML format XML  formats.

NPI Number : 1407502420 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407502420",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHRISTIANSEN",
    "FirstName": "CELESTE",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ETHINGTON",
    "OtherFirstName": "CELESTE",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "165 E LAKEVIEW DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEARFIELD",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84015-2394",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-830-7227",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1120 S RACKHAM WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MERIDIAN",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83642-1092",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-577-8672",
    "PracticeLocationAddressFaxNumber": "208-209-6058",
    "EnumerationDate": "02/28/2022",
    "LastUpdateDate": "07/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "6072992-3102",
          "LicenseNumberStateCode": "UT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "2871562",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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