Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP04947 | LA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APN0000011811 | TN |
NPI | 1164433694 |
---|---|
Provider Name | Miss Celeste Diane Perry |
First Address | Baton Rouge, LA 70810-0746 |
Second Address | Lafayette, LA 70503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APN0000011811 | TENNESSEE LICENSE (01) | TN |
APO4947 | LOUISIANA LICENSE (01) | LA |