Provider Demographics
NPI:1558714683
Name:KARJALA, CHRISTIE (LPN-MIV)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:KARJALA
Suffix:
Gender:F
Credentials:LPN-MIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HEDWICK ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-2618
Mailing Address - Country:US
Mailing Address - Phone:937-591-1837
Mailing Address - Fax:
Practice Address - Street 1:745 HEDWICK ST
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-2618
Practice Address - Country:US
Practice Address - Phone:937-543-9183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142017 M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188885Medicaid