Provider Demographics
NPI:1114788684
Name:CHRISTIAN, TANESHIA ROCHELLE
Entity Type:Individual
Prefix:MS
First Name:TANESHIA
Middle Name:ROCHELLE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E NORTHRUP DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5340
Mailing Address - Country:US
Mailing Address - Phone:405-417-7166
Mailing Address - Fax:
Practice Address - Street 1:415 E NORTHRUP DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5340
Practice Address - Country:US
Practice Address - Phone:405-417-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist