Provider Demographics
NPI:1598111809
Name:PANN, CHRISTINA (NC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PANN
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 DOBBINS ST STE C
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2700
Mailing Address - Country:US
Mailing Address - Phone:925-771-4240
Mailing Address - Fax:
Practice Address - Street 1:97 DOBBINS ST STE C
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2700
Practice Address - Country:US
Practice Address - Phone:925-771-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000000000133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education