| NPI | 1356763833 |
|---|---|
| Former Name | CELESTE STATES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12060) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056687) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2022-05-18 |