1275046393 NPI number — MS. CHRISTINA FINGERLE LMSW

Table of content: MS. CHRISTINA FINGERLE LMSW (NPI 1275046393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275046393 NPI number — MS. CHRISTINA FINGERLE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINGERLE
Provider First Name:
CHRISTINA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
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:
1275046393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4457 POPPS FERRY RD LOT 138
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIBERVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39540-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-697-8446
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15094 COUNTY BARN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-868-6524
Provider Business Practice Location Address Fax Number:
228-863-0096
Provider Enumeration Date:
11/11/2017

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: 104100000X , with the licence number:  M9170 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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