Provider Demographics
NPI:1235635475
Name:PEARSON, CHRISTINE M
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:PEARSON
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:PO DRAWER 70
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021
Mailing Address - Country:US
Mailing Address - Phone:575-233-3546
Mailing Address - Fax:
Practice Address - Street 1:300 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:NM
Practice Address - Zip Code:88058
Practice Address - Country:US
Practice Address - Phone:575-233-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR56984163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool