Provider Demographics
NPI:1619693827
Name:DARE, KHRISTINA
Entity Type:Individual
Prefix:
First Name:KHRISTINA
Middle Name:
Last Name:DARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3305
Mailing Address - Country:US
Mailing Address - Phone:937-974-8059
Mailing Address - Fax:
Practice Address - Street 1:148 FOREST ST
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3305
Practice Address - Country:US
Practice Address - Phone:937-974-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide