Provider Demographics
NPI:1093144347
Name:CHRISTIE, KERRI (IBCLC)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17806 N 34TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1213
Mailing Address - Country:US
Mailing Address - Phone:480-721-4585
Mailing Address - Fax:
Practice Address - Street 1:17806 N 34TH WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1213
Practice Address - Country:US
Practice Address - Phone:480-721-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN