Provider Demographics
NPI:1033549100
Name:SIDDALL, CHRISTINE CATHERINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CATHERINE
Last Name:SIDDALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7668 SW MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8119
Mailing Address - Country:US
Mailing Address - Phone:503-885-5000
Mailing Address - Fax:866-350-1311
Practice Address - Street 1:7668 SW MOHAWK ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8119
Practice Address - Country:US
Practice Address - Phone:503-885-5000
Practice Address - Fax:866-350-1311
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090000142RN163WC0400X
WARN00126996163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management