Provider Demographics
NPI:1083942734
Name:LAWHORN, CHRISTA R (RN MSN ANP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:R
Last Name:LAWHORN
Suffix:
Gender:F
Credentials:RN MSN ANP
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:RENADE
Other - Last Name:LAWHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1701E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4632
Mailing Address - Country:US
Mailing Address - Phone:951-658-4486
Mailing Address - Fax:951-925-1666
Practice Address - Street 1:4060 FOURTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2120
Practice Address - Country:US
Practice Address - Phone:619-718-9444
Practice Address - Fax:619-718-9440
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11416363LA2200X
OHRN259439-COAL163W00000X
OH11416-NP363LA2200X
CANP 19543363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse