1821799941 NPI number — JULIENNE ALICIA CHRISTOPHER MSW

Table of content: JULIENNE ALICIA CHRISTOPHER MSW (NPI 1821799941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821799941 NPI number — JULIENNE ALICIA CHRISTOPHER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTOPHER
Provider First Name:
JULIENNE
Provider Middle Name:
ALICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821799941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 MANANA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR CREST
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87008-9414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-537-8498
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 LOUISIANA BLVD NE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-4394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-302-1660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2023

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: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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