Provider Demographics
NPI:1205028891
Name:SMITH, CHRISTINE JULIANA (ANP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JULIANA
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:JULIANA
Other - Last Name:SCHWALM; DEBRESTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 E OSBORN RD
Mailing Address - Street 2:SUITE B150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5678
Mailing Address - Country:US
Mailing Address - Phone:602-264-4431
Mailing Address - Fax:602-266-3870
Practice Address - Street 1:1313 E OSBORN RD
Practice Address - Street 2:SUITE B150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5678
Practice Address - Country:US
Practice Address - Phone:602-264-4431
Practice Address - Fax:602-266-3870
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2754363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ241508Medicaid
AZZ117345Medicare PIN
AZZ117344Medicare PIN