Provider Demographics
NPI:1376178400
Name:HATLEY, CHRISTINA MAY (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MAY
Last Name:HATLEY
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6056
Mailing Address - Country:US
Mailing Address - Phone:208-773-1577
Mailing Address - Fax:208-773-8585
Practice Address - Street 1:1220 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6056
Practice Address - Country:US
Practice Address - Phone:208-773-1577
Practice Address - Fax:208-773-8585
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty