Individual provider Active NPI

Lara Marie Celli, NP

  • Family Nurse Practitioner
  • Eureka, CA
National Provider Identifier
1316346323
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95009171 Issued in CA
Practice address
2200 Tydd St
Eureka, CA 95501-1284
Phone
(707) 441-1624
NPI assigned
Aug 14, 2014
Last updated
Sep 19, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95009171 CA Primary
Registered Nurse 163W00000X 705211 CA

Addresses

Primary practice location

2200 Tydd St
Eureka, CA 95501-1284

Mailing address

670 9TH St Ste 203
Arcata, CA 95521-6249
Phone (707) 441-1624

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190123001956 CA Practitioner - Nurse Practitioner 2769729151 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95009171CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Open Door Community Health Centers Current Accepting new patients
Open Door Community Health Centers CurrentSince Nov 17, 2018 Accepting new patients
Open Door Community Health Centers CurrentSince Nov 17, 2018 Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

2200 Tydd St
Eureka, CA 95501
Phone (707) 441-1624

670 9th St
Ste 203
McKinleyville, CA 95521

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537315200000",
    "number": "1316346323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 9TH ST STE 203",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955216249",
            "telephone_number": "707-441-1624",
            "fax_number": "707-441-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 TYDD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011284",
            "telephone_number": "707-441-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CELLI",
        "first_name": "LARA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2018-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95009171",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "705211",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.