Provider Demographics
NPI:1255850152
Name:HART, CHRISTIE JEAN
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:JEAN
Last Name:HART
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 1:81 E FORREST FEEZOR ST
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2795
Mailing Address - Country:US
Mailing Address - Phone:520-603-9021
Mailing Address - Fax:
Practice Address - Street 1:81 E FORREST FEEZOR ST
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2795
Practice Address - Country:US
Practice Address - Phone:520-603-9021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3766385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child