Provider Demographics
NPI:1609392182
Name:CHRISTY, ALICEANN PAXTON (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ALICEANN
Middle Name:PAXTON
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MS
Other - First Name:ALICEANN
Other - Middle Name:
Other - Last Name:CHRISTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:943 N BROKEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5844
Mailing Address - Country:US
Mailing Address - Phone:402-312-7308
Mailing Address - Fax:
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN208138163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant