Provider Demographics
NPI:1356475420
Name:MYERS, CHRISTINA (RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 E STILLWATER LNDG
Mailing Address - Street 2:UNIT # 201
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9452
Mailing Address - Country:US
Mailing Address - Phone:217-244-5344
Mailing Address - Fax:217-244-1758
Practice Address - Street 1:1109 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4703
Practice Address - Country:US
Practice Address - Phone:217-244-5344
Practice Address - Fax:217-244-1758
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41196113261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service