Provider Demographics
NPI:1427389394
Name:WILLISON, CHRISTINA LYN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYN
Last Name:WILLISON
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 1:608 ANNFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-1302
Mailing Address - Country:US
Mailing Address - Phone:419-775-5329
Mailing Address - Fax:
Practice Address - Street 1:608 ANNFIELD DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-1302
Practice Address - Country:US
Practice Address - Phone:419-775-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400852310109376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide