1194247874 NPI number — CHRISTINE LORENTZEN HARRISON RN

Table of content: CHRISTINE LORENTZEN HARRISON RN (NPI 1194247874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194247874 NPI number — CHRISTINE LORENTZEN HARRISON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
CHRISTINE
Provider Middle Name:
LORENTZEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LORENTZEN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
WENDY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194247874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 HOSPITAL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUSANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96130-4808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-251-8108
Provider Business Mailing Address Fax Number:
530-251-8108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 HOSPITAL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUSANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-251-8108
Provider Business Practice Location Address Fax Number:
530-251-8394
Provider Enumeration Date:
07/13/2017

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: 163WP0808X , with the licence number:  482139 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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