Provider Demographics
NPI:1407393788
Name:CHRISTIANSON, BECKY
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:CHRISTIANSON
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 1:41797 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5315
Mailing Address - Country:US
Mailing Address - Phone:951-414-4040
Mailing Address - Fax:
Practice Address - Street 1:41797 CLARK WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5315
Practice Address - Country:US
Practice Address - Phone:951-414-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477626163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse