Provider Demographics
NPI:1346923505
Name:CHRISTIAN, CORA
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:CHRISTIAN
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 1:357 WILLOW RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8089
Mailing Address - Country:US
Mailing Address - Phone:601-316-4729
Mailing Address - Fax:
Practice Address - Street 1:2084 DUNBARTON DR STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5020
Practice Address - Country:US
Practice Address - Phone:601-316-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide