MEDICARE: CELESTE RENEE CHRISTIANSEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	6072992-3102	UT
2	363L00000X	Nurse Practitioner	2871562	ID

General Provider Information

NPI Number	:	1407502420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE RENEE CHRISTIANSEN FNP

Provider Business Mailing Address
First Line	:	165 E LAKEVIEW DR
Second Line	:
City	:	CLEARFIELD
State	:	UT
Zip	:	84015-2394
Country	:	US
Telephone Number	:	801-830-7227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 S RACKHAM WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1092
Country	:	US
Telephone Number	:	208-577-8672
Fax Number	:	208-209-6058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2022
Last Update Date	:	07/29/2025

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Directions to “ CELESTE RENEE CHRISTIANSEN FNP” Practice Location

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