Most Relevant Information
Provider Data
| NPI Number: | 1003034018 |
| Provider Name: | LYSTRA B WILSON-CELESTINE MD |
| Entity Type: | Individual |
| Taxonomy Code: | 207V00000X |
| Specialty: | Obstetrics & Gynecology |
| License Number: | MD00048034 |
Most Important Dates
| Enumeration Date: | 04/23/2007 |
| Last Updated: | 05/29/2018 |
Provider Practice Location
280 SIERRA COLLEGE DR STE 115
GRASS VALLEY
CA
95945
Practice Location Phone/Fax
| Phone: | 5304773119 |
| Fax: | 5302742077 |
Provider Mailing Location
3400 DATA DR
ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA
CA
956707956
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |
Suggested EMR
OBGYN EMR