MEDICARE: MISS GAIDA MAY CELIZ NP-C

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	363LF0000X	Family Nurse Practitioner	0024169672	VA

General Provider Information

NPI Number	:	1538430749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GAIDA MAY CELIZ NP-C

Provider Business Mailing Address
First Line	:	810 KEMPSVILLE RD
Second Line	:	SUITE 1
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-2723
Country	:	US
Telephone Number	:	757-313-5420
Fax Number	:	757-313-5521

Provider Business Practice Location Address
First Line	:	810 KEMPSVILLE RD
Second Line	:	SUITE 1
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-2723
Country	:	US
Telephone Number	:	757-313-5420
Fax Number	:	757-313-5521

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

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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