Provider Demographics
NPI:1477063808
Name:ANTHONY, CHRISTINA L
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:L
Last Name:ANTHONY
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 1:2602 MCLAUGHLIN DR
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5197
Mailing Address - Country:US
Mailing Address - Phone:951-775-1161
Mailing Address - Fax:
Practice Address - Street 1:2602 MCLAUGHLIN DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5197
Practice Address - Country:US
Practice Address - Phone:951-775-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health