Provider Demographics
NPI:1164997342
Name:REID, CHRISTA M (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:M
Last Name:REID
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21444 HWY 97
Mailing Address - Street 2:
Mailing Address - City:ORONDO
Mailing Address - State:WA
Mailing Address - Zip Code:98843-9750
Mailing Address - Country:US
Mailing Address - Phone:509-677-2429
Mailing Address - Fax:
Practice Address - Street 1:1230 MONITOR ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3534
Practice Address - Country:US
Practice Address - Phone:509-300-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00056048164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse