Provider Demographics
NPI:1578047445
Name:GARNER, CHRISTINA MICHELLE (LDN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:GARNER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MICHELLE
Other - Last Name:WELLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDN
Mailing Address - Street 1:107 ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8401
Mailing Address - Country:US
Mailing Address - Phone:413-441-5591
Mailing Address - Fax:
Practice Address - Street 1:107 ALFRED DR
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8401
Practice Address - Country:US
Practice Address - Phone:413-441-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2608133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist