Provider Demographics
NPI:1356447262
Name:PROCTOR, CHRISTOPHER ALAN (CNS, CRNFA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:CNS, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 BEALE ST
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8621
Mailing Address - Country:US
Mailing Address - Phone:928-763-1120
Mailing Address - Fax:775-227-0014
Practice Address - Street 1:3454 BEALE ST
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8621
Practice Address - Country:US
Practice Address - Phone:928-763-1120
Practice Address - Fax:775-227-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN087061163W00000X
CA281505163W00000X
AZAP1617364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ537590Medicaid
AZ537590Medicaid