Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 27031 | WV |
Y | 207VG0400X | Gynecologist | 25MA09840000 | NJ |
NPI | 1104250117 |
---|---|
Provider Name | Charlsie Khalisha Celestine |
First Address | Princeton, NJ 08540-1968 |
Second Address | Princeton, NJ 08540-1968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2013 |
Last Update Date | 31/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104250117 | (05) | WV |