Provider Demographics
NPI:1447768320
Name:COUNCELLER, CHRISTINA ANN
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:COUNCELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:COUNCELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:6731 SPRINGDALE CT
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9556
Mailing Address - Country:US
Mailing Address - Phone:503-332-8557
Mailing Address - Fax:
Practice Address - Street 1:6731 SPRINGDALE CT
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:503-332-8557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7327777163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine