Provider Demographics
NPI:1376784652
Name:MC NALLY, CHRISTINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:MC NALLY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:MC NALLY
Other - Last Name:CINEUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:220 S DOHENY DR
Mailing Address - Street 2:NUMBER 11
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2522
Mailing Address - Country:US
Mailing Address - Phone:818-287-1133
Mailing Address - Fax:
Practice Address - Street 1:4451 STANSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2718
Practice Address - Country:US
Practice Address - Phone:818-287-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162943164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse