Provider Demographics
NPI:1598394322
Name:MEACHAM, CHRISTINA NICOLE (STNA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:MEACHAM
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:209 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1912
Mailing Address - Country:US
Mailing Address - Phone:419-560-4157
Mailing Address - Fax:
Practice Address - Street 1:209 N COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1912
Practice Address - Country:US
Practice Address - Phone:419-560-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379718040401374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
379718040401OtherSTNA