Provider Demographics
NPI:1477785517
Name:SMITH, CHRISTA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18717 N MILLER WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-6899
Mailing Address - Country:US
Mailing Address - Phone:480-273-9484
Mailing Address - Fax:
Practice Address - Street 1:45012 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2842
Practice Address - Country:US
Practice Address - Phone:520-568-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP032102164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse