Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD00048034 | WA |
NPI | 1003034018 |
---|---|
Provider Name | Lystra B Wilson-Celestine |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Grass Valley, CA 95945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 29/05/2018 |