Provider Demographics
NPI:1548411036
Name:MOSIENKO, CHRISTINE ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MOSIENKO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 W BRILES RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7015
Mailing Address - Country:US
Mailing Address - Phone:623-376-9038
Mailing Address - Fax:623-376-9186
Practice Address - Street 1:6865 W BRILES RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7015
Practice Address - Country:US
Practice Address - Phone:623-376-9038
Practice Address - Fax:623-376-9186
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN107683367500000X
AZCRNA0446367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ172518Medicare PIN