=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598829301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CELESTE MARY SUMNER ANP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6465 GREENWOOD PLAZA BLVD SUITE 300
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-718-2953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6751 S CLAYTON WAY
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-718-2953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 119592
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------