Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP07993 | LA |
NPI | 1003215864 |
---|---|
Provider Name | Celeste Buuck |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70808-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 27/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2378597 | (05) | LA |