Provider Demographics
NPI:1043428741
Name:LAPORTA, CHRISTINE R (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:LAPORTA
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 1:233 W OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1351
Mailing Address - Country:US
Mailing Address - Phone:814-266-3345
Mailing Address - Fax:
Practice Address - Street 1:154 LAKEMONT PARK BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5900
Practice Address - Country:US
Practice Address - Phone:814-942-1903
Practice Address - Fax:814-505-1100
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN267636L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019468390001Medicaid