Provider Demographics
NPI:1417500372
Name:AHEARN, CHRISTINA (NP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:AHEARN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-0995
Mailing Address - Country:US
Mailing Address - Phone:503-397-4651
Mailing Address - Fax:
Practice Address - Street 1:1089 NAUTICAL DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:OR
Practice Address - Zip Code:97121-9101
Practice Address - Country:US
Practice Address - Phone:208-985-6284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201905763NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily