Provider Demographics
NPI:1063013548
Name:MOTT, CHRISTINE ANN HARDEN (RN-NIC, IBCLC, BSN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN HARDEN
Last Name:MOTT
Suffix:
Gender:F
Credentials:RN-NIC, IBCLC, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 MYRTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5123
Mailing Address - Country:US
Mailing Address - Phone:410-336-4353
Mailing Address - Fax:
Practice Address - Street 1:2225 MYRTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-5123
Practice Address - Country:US
Practice Address - Phone:410-336-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR-182375163W00000X
AL1-163676163WN0002X
ALL-163122163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-163676OtherNURSING LICENSURE
MDR-192375OtherNURSING LICENSURE
L-163122OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS