1386969889 NPI number — DR. CHRISTINE ANDREA RUSSELL AU.D.

Table of content: DR. CHRISTINE ANDREA RUSSELL AU.D. (NPI 1386969889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386969889 NPI number — DR. CHRISTINE ANDREA RUSSELL AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
CHRISTINE
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOBIN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AU.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386969889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 N COUNTY ROAD 25 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLVUE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80512-5922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-217-7087
Provider Business Mailing Address Fax Number:
970-797-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 N COUNTY ROAD 25 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLVUE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80512-5922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-217-7087
Provider Business Practice Location Address Fax Number:
970-797-1248
Provider Enumeration Date:
03/29/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  572 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)