Provider Demographics
NPI:1003387184
Name:LERBACK, CHRISTINE LYN (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYN
Last Name:LERBACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 PRIVATE ROAD 1512
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-4727
Mailing Address - Country:US
Mailing Address - Phone:316-207-1331
Mailing Address - Fax:
Practice Address - Street 1:359 PRIVATE ROAD 1512
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-4727
Practice Address - Country:US
Practice Address - Phone:316-207-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily