Provider Demographics
NPI:1043209059
Name:CIFELLI, CHRISTINE JO (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JO
Last Name:CIFELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:1090 3RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3485
Practice Address - Country:US
Practice Address - Phone:530-543-5660
Practice Address - Fax:530-542-1619
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6374363L00000X
CA425110163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043209059Medicaid
NV1043209059Medicaid
CAZZZ05302ZMedicare PIN
CADO709ZMedicare PIN
CA1043209059Medicaid