Basic Information
Provider Information | |||||||||
NPI: | 1548407976 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CELONY | ||||||||
FirstName: | EMANEZ | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CELONY | ||||||||
OtherFirstName: | EMANEZ | ||||||||
OtherMiddleName: | DARLIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LPN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 3806 MOUNT CARMEL LN | ||||||||
Address2: |   | ||||||||
City: | MELBOURNE | ||||||||
State: | FL | ||||||||
PostalCode: | 329016712 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3219534710 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 900 S FEDERAL HWY | ||||||||
Address2: | SUITE 305 | ||||||||
City: | STUART | ||||||||
State: | FL | ||||||||
PostalCode: | 349943725 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8008794471 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/07/2009 | ||||||||
LastUpdateDate: | 01/07/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN5163533 | FL | Y |   | Nursing Service Providers | Licensed Practical Nurse |   |
No ID Information.