Provider Demographics
NPI:1598256323
Name:WADDELL, CHRISTINA (LVN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WADDELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9999 SPENCER HWY APT 411
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4063
Mailing Address - Country:US
Mailing Address - Phone:713-569-3519
Mailing Address - Fax:
Practice Address - Street 1:9999 SPENCER HWY APT 411
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4063
Practice Address - Country:US
Practice Address - Phone:713-569-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322349164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse