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Individual

MRS. CELIANNE MARIE BACON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
1917 W FAIDLEY AVE, GRAND ISLAND, NE 68803-4642
(308) 398-0350
Mailing address
39413 CHADUZA RIDGE RD, VALENTINE, NE 69201-2331
(402) 389-1303

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
113298
NE

Other

Enumeration date
11/04/2020
Last updated
11/04/2020
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