Provider Demographics
NPI:1003421447
Name:VERRE, CHRISTEN MARIE (BMO 79048)
Entity Type:Individual
Prefix:MS
First Name:CHRISTEN
Middle Name:MARIE
Last Name:VERRE
Suffix:
Gender:F
Credentials:BMO 79048
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:640 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7126
Mailing Address - Country:US
Mailing Address - Phone:727-510-3120
Mailing Address - Fax:727-528-7827
Practice Address - Street 1:640 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7126
Practice Address - Country:US
Practice Address - Phone:727-528-7827
Practice Address - Fax:727-235-0063
Is Sole Proprietor?:No
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL79048247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist