Provider Demographics
NPI:1326317645
Name:DUVAL, CHRISTINE ERIN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ERIN
Last Name:DUVAL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 GREEN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-3013
Mailing Address - Country:US
Mailing Address - Phone:978-235-1784
Mailing Address - Fax:
Practice Address - Street 1:364 GREEN ST APT 4
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-3013
Practice Address - Country:US
Practice Address - Phone:978-235-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN67288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110022061BOtherGROUP MEDICAID NUMBER