1689878696 NPI number — MRS. CHRISTIE RAE BLACK WISSINGER R.N.

Table of content: MRS. CHRISTIE RAE BLACK WISSINGER R.N. (NPI 1689878696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689878696 NPI number — MRS. CHRISTIE RAE BLACK WISSINGER R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK WISSINGER
Provider First Name:
CHRISTIE
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLACK
Provider Other First Name:
CHRISTIE
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689878696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8645 E CHIMNEY SPRING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85747-5646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-574-2120
Provider Business Mailing Address Fax Number:
520-225-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 E 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85719-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-225-4123
Provider Business Practice Location Address Fax Number:
520-225-4001
Provider Enumeration Date:
06/13/2007

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: 163WS0200X , with the licence number:  RN143669 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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