Provider Demographics
NPI:1174195408
Name:BURNELL, CHRISTIE MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MARIE
Last Name:BURNELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:MARIE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:488 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:PATON
Mailing Address - State:IA
Mailing Address - Zip Code:50217-8024
Mailing Address - Country:US
Mailing Address - Phone:515-370-5348
Mailing Address - Fax:
Practice Address - Street 1:488 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:PATON
Practice Address - State:IA
Practice Address - Zip Code:50217-8024
Practice Address - Country:US
Practice Address - Phone:515-370-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG164643363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health