1700054335 NPI number — CHRISTINA LORRAINE WOOLDRIDGE PA-C

Table of content: CHRISTINA LORRAINE WOOLDRIDGE PA-C (NPI 1700054335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700054335 NPI number — CHRISTINA LORRAINE WOOLDRIDGE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLDRIDGE
Provider First Name:
CHRISTINA
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORMAND
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700054335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18444 N 25TH AVE
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85023-1261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-537-5600
Provider Business Mailing Address Fax Number:
866-939-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10494 W THUNDERBIRD BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-6122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-537-5600
Provider Business Practice Location Address Fax Number:
866-939-2673
Provider Enumeration Date:
02/17/2008

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 5024 , 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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