Provider Demographics
NPI:1225788615
Name:BAZEMORE, CHRISTA MICHELLE
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MICHELLE
Last Name:BAZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LITTLE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EURE
Mailing Address - State:NC
Mailing Address - Zip Code:27935-9791
Mailing Address - Country:US
Mailing Address - Phone:252-319-0138
Mailing Address - Fax:
Practice Address - Street 1:64 LITTLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:EURE
Practice Address - State:NC
Practice Address - Zip Code:27935-9791
Practice Address - Country:US
Practice Address - Phone:252-319-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program