Provider Demographics
NPI:1548588783
Name:THEODORE, CHRISTOPHER WAYNE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:THEODORE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:3810 CENTRAL AVENUE, SUITE H
Mailing Address - Street 2:MIDSTATE MEDICAL SERVICES
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6921
Mailing Address - Country:US
Mailing Address - Phone:501-525-5840
Mailing Address - Fax:501-525-1762
Practice Address - Street 1:300 WERNER
Practice Address - Street 2:ST. JOSEPH HOSPITAL
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6921
Practice Address - Country:US
Practice Address - Phone:501-622-1875
Practice Address - Fax:501-525-1925
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR#R72957163W00000X
AR#CTP000134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse