Provider Demographics
NPI:1164919064
Name:QUEVAL-CHUNG, CHRISTINE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:QUEVAL-CHUNG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:QUEVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:14175 W INDIAN SCHOOL RD STE B4
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8494
Mailing Address - Country:US
Mailing Address - Phone:623-498-9988
Mailing Address - Fax:
Practice Address - Street 1:3864 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4703
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-212-6250
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441853Medicaid