Provider Demographics
NPI:1205026051
Name:CHRISTNACHT, DEBRA ELIZABETH (ICCE)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ELIZABETH
Last Name:CHRISTNACHT
Suffix:
Gender:F
Credentials:ICCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 PHILLIPS RD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6337
Mailing Address - Country:US
Mailing Address - Phone:253-566-8788
Mailing Address - Fax:
Practice Address - Street 1:6711 PHILLIPS RD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6337
Practice Address - Country:US
Practice Address - Phone:253-566-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8065521Medicaid