Provider Demographics
NPI:1477611309
Name:CORMACK, CHRISTINE (FNP)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:
Last Name:CORMACK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CORMACK-DAUWALDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:365 PEARSON DR
Mailing Address - Street 2:SUITE5
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:559-788-2175
Mailing Address - Fax:559-788-2227
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:SUITE5
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:559-788-2175
Practice Address - Fax:559-788-2227
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 8733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily