Individual
CELINE ANN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 350-1570
(919) 790-0108
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(877) 498-4490
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
5005905
NC
363LA2100X
Acute Care Nurse Practitioner
R17970
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041200700
—
MD
01
—
607156012
DEPT OF LABOR
—
01
—
CS95AA97381801
CAREFIRST
—
01
—
V8140012
CAREFIRST
—
Enumeration date
02/13/2007
Last updated
08/02/2024
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