Provider Demographics
NPI:1568807204
Name:BOUGHTON, CHRISTINE A (RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:A
Last Name:BOUGHTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON STREET
Mailing Address - Street 2:ELMIRA PSYCHIATRIC CENTER
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2898
Mailing Address - Country:US
Mailing Address - Phone:607-735-3560
Mailing Address - Fax:607-732-2392
Practice Address - Street 1:100 WASHINGTON STREET
Practice Address - Street 2:ELMIRA PSYCHIATRIC CENTER
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2898
Practice Address - Country:US
Practice Address - Phone:607-735-3560
Practice Address - Fax:607-732-2392
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4543191163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent