Provider Demographics
NPI:1346865656
Name:STEPHENS, CHRISTINE ALISON (LVN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALISON
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ALISON
Other - Last Name:CONNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 CHALLENGER WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5441
Mailing Address - Country:US
Mailing Address - Phone:707-565-9500
Mailing Address - Fax:
Practice Address - Street 1:2835 BOWEN ST
Practice Address - Street 2:
Practice Address - City:GRATON
Practice Address - State:CA
Practice Address - Zip Code:95444-9347
Practice Address - Country:US
Practice Address - Phone:707-596-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2681777164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse